HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO.BE ACCEPTED.', ''n nn��
Date: Permit Number: ��®ll/ " 45_3�
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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 Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address: S
Legal Description: d V, IIQS emad o
P ro pe rty Tax I D#: �5�a-- �05" do� a—' GCSa Lot No.
Site Plan Name: Block No.
Project Name: SQ.ril I QX Ao reS
Setbacks Front Back: Right Side: Left Side:
S
R I ENDMMMIMMUM
Q = C GS 360 SH (Guas_) ,THP14c' r
i = e GT d14X 1MW1 (Crit)
C G I 31.0 SH ( (5) TM PflC'T
Additional work to a er orme under this permit—Phecklaill Wapply:
HVAC �Gas Tank E]Gas PiMping _ShuttersNindows/Doors
11 Electric 0 Plumbing OSprinklers Generator Roof
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction:$ .3� ! 7c? .7� Utilities:]Sewer OSeptic Building Height:
s �.
Name Rickarok M(xr 11G NQ - Name:
Address: 74l0 S .Dmarl,_Dr. l0'7j) Company: ► S _
City: TanSQ.1'1 4ieac- State: rL. Address: \
Zip Code: 3`4957 Fax: City: \ State:
Phone No. - ��q� to� I -- ?�Ct 3 2 Zip Code: Fax:
E-Mail: Phone—Wo. ��O
Fill in fee simple Title Holder on next page ( if different E-Mail:
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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 the permit 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 in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencingwork or re ;or ' our Notice of Commencement.
s
_Signature o essee/Agent Signature of Contractor/License Holder
STATE OF FLORI `^ STATE OF FLO ID
COUNTY OF 2 V 1 COUNTY OF
T e r ing instuu was acknowledg dj before me The f r oing instrume t w s acknowledged before me
day of 20y this day of , 20 by
n� 1
(Name of person acknowledging) (Name of'person acknowledging)
�11 1 L_.,�21 LA , A 00A -a
(Signature of NotaryPubli - to of Flonda (Signature of Notary Public-State of Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced c
Commission NoEZILS b �J (Se Qt �e}�c AELI b �c,,5 (Seal)
+= MY COMMI SION#EE 855825
?'•• o, EXPIRES: cember28,2016
2
ru o ry PubNc Undenttiters MELISA ARMENTO
Revised 07/15/2014 4 MY COMMISSION#EE 855825
P EXPIRES:December28,2016
F,,F Bended Thru No Public Undenwiters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS