HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED —t t�
Date: a,1 1� Permit Number: i�d t '� 9
k RECEIVED JUL
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial —4Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT,LOCATION:
Address: loop S Ocen-")
Legal Description: �u_. '(DEL_ S'oL_ C,2N ob UN t i A A- 040
0Vr_S G ( v 2 39 21 – 33 5-
Property
Property Tax ID#: L45717-- 701— 0CA3-C —C — Lot No.
Site Plan Name: L 1 ePAoJ Block No.
Project Name: L_I ePA'--
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK.`
CONSTRUCTIQ;N,INFORMATION:
Additional work to be ertormed under this permit—check all appy:
HVAC Gas Tank E]Gas Piping _ShuttersWindows/Doors
1-1 Electric ❑ Plumbing O Sprinklers Generator _Roof
Total Sq. Ft of Construction: SFt. of First Floor:
0.7
Cost of Construction: $ 9yi�n� Utilities: _Sewer O Septic Building Height:
OWNER/LESSEE ' CONTRACTOR:
Name /�hl / Name: ic�r.�Z
Address: JkC0 S^nCE� � �{�� b�A' Company: 1E�IS0tj ' FSG lr'T U11.t/n1uN�
City: )E7 soi sahz l ' State: F, Address:k«Z-> No)
Zip Code: 3495-2' Fax: City: State: PL,
Phone No. 22 bG1�`� Zip Code: 34-clC, Fax: (0qz -q?�'�(.
E-Mail: Phone No. (097--6 oRy
Fill in fee simple Title Holder on next page (if different E-Mail: (M-C-l+A ELL 6cx.)Q -v 1" ,O 4�1' •C-�1
�from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SOPPLEMENTA,L CONSTRUCTION LIEN LAW INFORMATION:
z..
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize thepermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit,I do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result i your paying twice for
improve nts to you ro erty. A No 'ce of Commencement must be.r rd d p d on the jobsite
bef the st inp io f you int d to obtain financing, consult h e a torney before
c mencin or r d'n o Notice of Commencement.
I s
_Signature of Owner/ sseAgent ��� Signature o Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Si {)CIC COUNTY OF
The forgoing instrument was acknowledged before me The forgoi g instrument was acknowledged before me
thi�/_Od y of 2014 by thi�/_�y of �U_t)Z_X ,2014 by
rel mviy
(Name of person acknowledging) (Name of person acknowledging)
(Signa of Notary Public-State of Florida) (Sign atur f=Notary Puublic-State oT Florida)
Personally Known ✓ OR Produced Identification Personally Known ✓ OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. Commission No. (Seal)
ANN M.GAUMOND ;o� Y•'t ;•; ANN M.GAUMOND
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^` EXPIRES:December 7,2018 =°` EXPIRES:December 7,2018
Revised 07/15/ ' °�,1°e Bonded Thru Notary Public c Underwriters pf oe' Bonded Thru Notary Public Underwriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS