HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: Permit Number: 07: �
RECEI'.'-D AUG 19 7676
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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 X
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line Qao
,PRO PO IMPROVEMENT LOCATION
Address: /�0 e_V441 1_)riye,
Legal D scription: ��eF�- ��i /fD�2Z� (,l�i' a i`e �7�� 2—o4- 7
PropertyTaxlD#: � � C�S"dd��—da�'� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: -'
OOr- �Q ce Yds h-Fs C 3 ) Re_piave and �e 4 ce__
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CONSTRUCTION INFORMATION:
Additional work to a er orme under this permit—c ec a _appy:
HVAC be
Tank []Gas Piping Shutters Windows Doors
11 Electric ❑ Plumbing Sprinklers Generator _Roof Roof pitch
Total Sq. Ft of Construction: S . of First Floor:
Cost of Construction: $ I OD Utilities:cn Sewer O Septic Building Height:
OWNER/LESSEE.° .
'`° CONTRACTOR:'
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Name OL ih S d Name: q0'5( -p -:::I- So
Address �9_00)Jsi te, Dptvt Company: Gss/ C 7'
City: Lot- 1-z«-2.. State: l �-- Address:
Zip Code: Fax: 772 Y o2 yo City:, or+ Sl� State:_L,
Phone No. 3 7 O .S_& / Zip Code:3 4 9 8 7 Fax: 7?.?-- y Z,9oz/
E-Mail: Phone No.77Z 3-70 6 b
Fill in fee simple Title Holder on next page ( if different E-Mail: I�I/l�fG i /- 7�'Gw y� Oo,Co
from the Owner listed above) State or County License:_C,6C 031_29�1
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 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
comLmencing work or record' our Notice of Commencem t.
Si a re of wn r/ ssee/ ctor as Agent for Owner ture of o r or/License Holder
S ATE OF FLORIDA TATE OF FLORIDA
COUNTY OF COUNTY OF • L Or-V",
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this\`\ day of 0, 20 �r- by this day of CX 20 \C_by
5�0r
(Name of person acknowledging) (Name of pe son acknowledging)
(Signature of Notary Pub ic-State of Florida " (Signature of Notar ublic-State of Florida )
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Personally Known F=__OR Pro uce I �,(�icb*rY, ?p16 Personally Known OR Produce tde Aifica Ngn
Type of Identification P'rodt; . ` iresD Type of Identification Proc(y,r��,a p
Public
Commission No. ". � al)g n alio1ary Assn., I ,`�= Notary it Dec 85876116
J �, hN `Y Commission No. - My Comm• �a
... n _tea 3' - , C mi sr
JF, go or om hrou h National Notary Assn Y
c• �'%;°;���`` Boned 9 ..�,�,��r�•.i=� .
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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DATE
COMPLETE
INITIALS