HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE'INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED / C,
Date: � �o�• � (o Permit Number:
Building Permit Application RECEUVFrh
Planning and Development Services AUG 12 201
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
PRQPOSED IN`IPRQVEMENT LOCATIQI LLL
L _, _..
Address: t)16 S -4- t�G� 5
Legal Description: �'t O�_� ^ �11P��►S S I l� f�a se L,.0 T I J g
Property Tax ID#: i31 Z. Stao• flog •gym"$ Lot No. )bS
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DT ILED DESC IPTIONQF WORKS � ' s � � �� r
i s
k,4NY-o5 cLocMcAot�jz. CI) A L 4__
C,-X)
Additional work
)0;NeINer ORM�►Tu..nd�er this permit—check a, app Y:
tormed
ll that
❑HVAC 11 Gas Tank Gas Piping _
p g S hu
tters Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft•of Construction: SFt. of First Floor:
Cost of Construction: $ Utilities:n Sewer 0Septic Building Height:
OWNER LESSEE � r 4 �
�'� � � ���� �CONTRAGTOR
� '.�
Name o C A eta( A. Name: - _
Address: ,5 7-7e G� 5c,� ,a,• L^f Company: T-6BLey
C..
City: /c32 ; ,P/, State: Address: CIL ec-4
Zip Code: 3 J Y,�'l Fax: City: a6A-0 r+ State:.
Phone No. ,_7-2 - 77- Y.2 4�, 3- Zip Coder q 614 L4 Fax"11c_�-33y'- Ips g
E-Mail: ._ Phone No. "1 a - 3q - 10 11
Fill in fee simple Title Holder on next page (if different E-Mail: aAe$ Q. cLA aA3-
from-the Owner listed above) State or ounty License: 6(!C (3 LIE 131�-3
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
J
AICONSTRUCTCrNll �PLAIN tRl
fNFORMAT {)Ng _
S11I �l.EtUIENT: N
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
commencing work or recording our Notice of Commencement.
�:'.. s
Sig ature of wner/Lessee/Agent .;. Sign ure of ontractor/License Holder
. . ;••
STAT ORIDA roe STATE OF FLORIDA
COUNTY OF ` ' c COUNTY OF�049P:4
o �
The forgoing instru nt was acknowledged before vo> The forgoing instrument was acknowledged before me
this_clay of 20 by m this�day of T 20/�by
Cn
z M m
� a' =
Cr
c
(Name of person acknowledging) z3� �� (Name of person acknowledging)
,p �N
(Signature of N6iary Public-State of Flo Ida ) S' a ure of Notary Public-Sta e f Florida )
Personally Known OR Pro uc d Identi ication Personally Known _OR Produced Identification
Type of Identification Produced Type of Identification Produced
,
Commission No. (Seal) Commission No. - Z;a.••.
My COMMISSION#FF181681
o..�,,..= edam er 8,2018
Revised 07/15/2014 '-W)398-0153 Floridallotaryservice,com
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS