HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE.COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: JC, / Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation.Division ?
2300 Virginia Avenue,Fort Pierce.R 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
PROPt4SED'IfVIPRCt1/EMENT IQC �TIf}N
Address: I0(o r 6r— .__F�•P%-evr 2 •11c"-
Legal
11c".Legal Description:T5s. r1S 517
Property Tax ID#:_35-3`Z- 5lo3-®cAU`OQO=5- Lot No. /0
Site Plan Name: ,,// ii i n K. Block No.�
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Project Name: e% f oce 1(�A-e "r F PI-erc.c �I L.Cig�
Setbacks Front Back:. Right Side: Left Side:
DETAILED DESCRIPTION QF WGiIC r
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CONSTRUCTION IN�FORNiAT1Qly'�F �
,z nt .•., ,H. . .
A �i�tig n or to oob�ormed under this permit-c ec a appy:
L"JHVAC E] Gas Tank ❑Gas Piping _Shutters a Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ . 0(7_ utilities. �S ptic Building Height:
C?1NNER/LESSEE r ""b "T
� ..
Name Name: Ra 1 10h Ocj&ct 0
Addre.". Company:.4iy A- 4)LA)
Citybr- State —L, Address:-50 N 9- 'N lxt-e L�WSA 1>-1
Zip Code: Fax: - City: -'-4QCL, _ State:-:?-/
Phone No. x'33 Lou Zip Code:�efgSnk — Fax:'7-1a-cl63
E-Mail: Phone No.^77;�L-191 -a(n 0,5_
_Fill in fee simple Title Holder on next page(if different E-Mail: r C
from the Owner listed above) State or County License: '
If value of construction is$2500 or more,a`11CORDED Notice of Commencement is re (uired.
SUPPCEMENTAC CONSTRUCTIQNLIEJhCAW`INFORMATION
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 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
commencing work or recording our Notice of Commencement.
S
_Signature o Owner/Lessee/Agent Signature of ontractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Si-Luc—( Co COUNTY OF 5-hAkC V-C Co
Th going instru)nen was acknowledged before me The forgoing instrument Was acknowledged before me
thiday of IJL 20/_(, y this�day of 20 by
�,.� ev%, ,
(Name of pe on acknowledging) (Name of person acknowledging)
(Signature of Notary Publi -State Florida) (Signature of Notary Public-Stat of Florida)_
Personally Known /OR Produced Identification Personally Known OR rod6 Ide(g}ij ggNf^.e .1 RE, N
Type of Identification Produced :=
Type of Identification Produced YP _ 21 78
•f•
i % •;;o�p' XPIRES July 31.201
Commission Nod (Seal) Commission No.�f ^1 .;(Sea FhxdnNw;a•}S�«icr.::un
. CHRISTINE A JORDAN
Revised 07/15
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•= MY COMMISSION#FF235578
XPIRER July 31 2019
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1481 1S�`d::a3 floruliNrrs•y Se nu:cwr
REVIEWS R PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS