HomeMy WebLinkAboutBuilding Permit Application J
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ,may
Date: Permit Number: '� O� OC-)
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 X—
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
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Address:ca O g o�� .s� 3—dL .y . Q1 p 1(Y'iC_ r L. 1 i
Legal Description: S-C.,r_ - c:
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Property Tax ID#: q 1- 3 • 0 03 • V 00 -Q- Lot No. 014
2137 38 FROM NE COR OF SEC RUN S 89 DEG 55 MIN W ALG N LI OF SEC 790.37 FT TO NWLY
RNV GLADESCUTOFF RD, TH S 44 DEG 43 MIN 30 SEC W ALG SD RNV 2250.54 FT FOR POB, TH N
45 DEG 16 MIN 30 SEC W 1650 FT, TH S 44 DEG 43 MIN 30 SEC W 150 FT, TH S 45 DEG 16 MIN 30
SEC E 1650 FT, TH N 44 DEG 43 MIN 30 SEC E 150 FT TO POB(5.68AC)(OR 2320-2413: 2931-1191;
2973-2462)
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional workto orme under t is permit-check a appy:
0HVAC �Gas Tank []Gas Piping 1J _Shutters Windows/Doors
Electric O Plumbing O Sprinklers O Generator O Roof
Total Sq.Ft of Construction:: S . Ft.of First Floor:
Cost of Construction:S 7S UtilitiesT]Sewer O Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name m:6v-% , �P,I Name:
R
Address: QL 0 o A Cel aL r-c- ri 11k 6W U Company: !NQIjk'A_&kC S+ru CtWAA
City:�Q�Vt>'p State•. Address: S
Zip Code:3%I d" Fax: City: "� . f%r_vc e 1 State:
Phone No. :1:12- _ !41-A - ke LA 2.. Zip Code: Sg0t Sr 1 Fax:.111-14(11 :SO3-?
E-Mail: Phone No. -34
Fill in fee simple Title Holder on next page(if different E-Mail: o 3, 9_xd .
from the Owner listed above) State or County License: %Lfic 1��7''� 3 9
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW 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 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 y ur property.A Notice of Commencement must be record and posted on the jobsite
before the first i edion. if you intend to obtain financing,consult with I r or an attorney before
commencin or recordin our Notice of Commencement.
s
XS' ature of r/Lessee/Agent Signatur of Contractor/License Holder
ATE OF FLORIDAQ� ii STATE OF FLORIDAC( LL
COUNTY OF � 1Al Gid COUNTY OF. JT
The folgoing instru ent was acknowledged before me The for ing Instruppent was acknowledged before me
this day of 20/L bv this day of 20 by
vI , ►�I� � leY
(Name 6NArson acknowledging) (Name of person acknowledging)
(Signat a of Notary Public-State of Florida) (Signa re of Nota7ftbl' -State of FloridaPers ally Known .�•� Produced W01I2c�RCorCH Perso ally Known ,(Ot�cgduced IdagaMimENCH
Type of identificatio _ �: Notar Public-State of Florida Type of Identification Pio < State of Florida
-
:•: :•5 My Comm.Expires Dec 1.2017 ' E My Comm.Expires Dec 1,2017
Commission No. Com(ftagn #FF 069924 Commission No. �; Coi(5@aibn # FF 069924
����,,•` Bonded Through National No Assn. ''•8�
9 aryl Bonded Through National N�Kary .
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS