HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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:
Gay e -")cccs
Address: /� Y I `� Ln
Legal Description: �aj Creek PhUst ll-
Property Tax ID#: 21-�Xi2` j�� Wri-_T Lot No.
Site Plan Name: I Block No. JJ 4
Project Name: T HM w4yers
Setbacks Front Back: Right Side: Left Side:
rnsi.11 like 6- like yld e doors 2ol,4 F6c
11ditional work to be performed un er t is permit-check all that appy:
_Mechanical Gas Tank _Gas Piping _Shutters /Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq.Ft of Construction:..ff nn Sq.Ft.of First Floor:
Cost of Construction:$ `l,4N�i-� Utilities: —Sewer _Septic Building Height:
Name 1 Name: r �n
Address:_ `b('I V1 LA Company: M(Y1 Lv�!=,rise ,,C &cum A ixiray� +�w
City: PtI,4 S4: 1A re State:FL Address: 005 Tomahaok D�-
Zip Code: '417 RD Fax: 1J�4 City. Dian 4..b, ez.rh State: F1
I Phone No. (T72) r--CM Zip Code: 3Z937 Fax: 32.1-777- 423 y
E-Mail: Lr A Phone No. 772.337-4'170
—
Fill in fee simple Title Holder on next page(if different E-Mail: Lu}e55h4unna iahoz•c-a�.
from the Owner listed above) State or County License: j I
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGN ER/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 Coup 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
commencing work or recordingvour Notice of Commencement.
s
_Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLO�IpA ua� STATE
OF O CYC
COUNTYOF TJCrd
The forgoing instru ent was acknowledged before me The forgoing instrument was acknowledged before me
this�dayof�.u,!, 20 Eby this J day of AQU&F 20 &by
1�1&w4
JWcs rYl lt{�S
(Nam ers ledging) (Name rson ackn dging)
UeWpPd'cu(.c
State of Florida) ( f ublic State of Florida)
R Produced Identification t OR Produced Identification
yed Typeo entificati roduced I�
GRO]xE SDG I '''�.}}},, Zkaxt aZlGkil
COssion .F MY LOMMSGCNr njgAeSmi ion NO. J �`I;al)MY�^pMuls a cpy
EXPIRES-June2,20!9 `_t EXPRES uni,25.20
PontleUiAru WIW PuO�'^.I:,ce
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
zd = x f
n =°.I �' � 7� � Ire•�
3 o WW g
m £ z2 o n a
`^ ii11SS fA
n m
Z�
❑ n 3 A zm y m
o � e m i
m ozf 2 u Nm C 3 0 _ FFW�'m ❑ c ��n❑
20 r W wl2 f/1 A 3 r N N xN p� Z 2o
b m
oo� ar11H
>
o xD� rywomp25
m ;3 c
li
� o$ Qimpic
Z
W_q�-' QL' Z n. -�.I rWi q
• 3 �ir A v �' Q N $ �° cps Q 'r o D o o m
� g o81 p � Z •
4 Ati Z QZ 0 A� zz = ❑
QQ
� 2 c
Q�b Wo y
❑ Y W ❑ D N/JW�
~W-
y �Wcn�
o - m Z C 10.. w O O p Z Z y
N m m ❑ ��flx
m y Z
ET
O O b 4 0 0 4 O W O O O O O c O
G O G G C
fi
00000 to 2. Z 2 Z 2222 Z Z 2 Z 22.Z ZZ Z2 % vonm
0 52
n n d a
m �
m �
a" ❑
m
\ m
m on R sNm
g I}/� � � � cm,N a❑q A O ry N
3�' om mon v nm„
V'
C3
a m