HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED c�
Date: 3�� 1� Permit Number:
R E C E I'.'^i� �1iJu 31 7.D16
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: To Select from dropbox, click arrow at the end of line.w)��-4-z',,s*"
PROPOSED IMPROVEMENT LOCATION:
Address: lS ,VAi, ioxr b2, LU r //11
Legal Description: T }R Z-'A'Z U R E0,044_1 PIR R PWk
� ca ( 0 R S-os - /9 � 7
Property Tax ID#: �Q J - d f 0 O/5 6 b p -� Lot No. _
Site Plan Name: / so t9 L 0.. c,/a S% P(1?_ 2K' Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
7-0 zi s'lg- I 1 4�RIr✓i wA y X39 7W r6 J46C,s/E -L 6-0 X0
CONSTRUCTION INFORMATION:
Additional work toe nerformed under tispermit-check all that appy:
HVAC 0 Gas Tank F]Gas Piping _Shutters Q Windows/Doors
11 Electric 0 Plumbing []Sprinklers D Generator D Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ ozx ,D (�3 Utilities: Sewer ElSeptic Building Height:
OWN ERAESSEE: CONTRACTOR:
Name )WR.,L IV& RR,4 Name: G/?'e
Address: AS 3VZ A&V/0/Y /25S L Company: P1,?,o_G" ,,,11A i2_
City: Pax i S 7 )_t,C<_4, State:FG i Address: 6l16(2 4) 14X//1_C, /0 r/2,
Zip Code:3 Fax: City:/'cQ✓ S7 1 vG/iZ State: }-L,•
Phone No. '�7> 2 -2 O ` / cJ Zip Code:,__�L/SIS-z? Fax:
E-Mail: Phone No. ��_-�- y161-_��>' ,P _
Fill in fee simple Title Holder on next page if different E-Mail: LiN!!�-aURP - / (5 >> AAI/,7,mac /from the Owner listed above) State or County License: C.e\C 01�
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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 your property.A Notice,pf_Commencement must be recorded and poste the jobsite
before the first inspection. If you intend obtain financing,consult with lender c an a before
commencing work o , ecordin r' tice of Commencement. /
S
Signature of O er/Lessee/Contractor a gent for Owner Signature ontractor/ cense Ho r
STATE O FLORIDA STATE OF FLORIDA
COUNTY OF •l-U c1 COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this Z day of ayy -by this3� day of 20 ��0 by
Cr 4-4!!S C�i y L\vvcA.�U r q
(Name of person ack owledging) (Name of persona knowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary P lic-State of Florida)
Personally Known OR Produced Identific 4 _„tib Personally Known OR Produced Identifi
Type of Identification Produced 1, L- Ura o�—o pe of Identification Produced –��0pOW
Commission No. I FEt—'A vat \�����J�O Commission No.
;q; ,►( � � is
Revised 0.7/15/2014
REVIEWS FRONT NING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS