HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: � ` �� Permit Number:
REr�71 :- �, ,
Buil .ding, 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:
.-PROPOSED IMPROVEMENT LOCATION:
Address: '7l�1 (o l�I�� r�S�i4�( Aloe",
Legal Description:
Property Tax ID#: 13 Q I (o it- 6039 –0�6 - 0 Lot No.
Site Plan Name: Block No. 0 a
Project Name:
Setbacks Front Back: Right Side: Left Side:
-DETAILED DESCRIPTION OF WORK:
t�c�pl�U'�S 3. Afc- t--'VL fol Z.°r/C L-7 HtgI e,./-
CONSTRUCTION
,./CONSTRUCTIONI.NFORMATION
Additional work to be performed under this permit–check all that appy:
HVAC _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
m
Cost of Construction:$ J��y' Utilities: —Sewer —Septic Building Height:
OWNER-/LESSEE CONTRACTOR`.;
Name,j go �R✓� Govt,. Name C7
Address: �9/��'' �`acS ' �`2 Company:- / Lei-i '�Fe,n�,�:,:, :�...!-l/LAAc
City: State: oO'�L- Address:- 6f!✓� $S =;EJn r
Zip Code: 3 Fax: City: A r?Ce Stater
Phone No. 7?3, 3ScC'- 393G Zip Code: .3�5'�� Fax:?7a. �//� �
E-Mail: Phone No. 7?a.- `&-7- 3aao
Fill in fee simple Title Holder on next page(if different E-Mail: 4---d--' ""tel/ Soq+" -.4e_
from the Owner listed above) State or County License: CMCJ f/ S/ ?,9
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL-CONSTRUCTION LIEN,-LAW INFORMATION::
DESIGNER/ENGINEER: V Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording your Notice of Commencement.
L/ G , �'� _ , s
ature of Owner/Lessee/Contractor as Agent for Owner S' ture of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF -�j�- LSC e$ COUNTY OF ' L
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this\'day of SK, 20 �E;_by this 1 day of20�G by
(Name of pers n acknowledging) (Name of person acknowledging)
(Signature of Notary PuVic-State of Florida) (Signature of Notary blic-State of Florida)
Personally Known OR Pr ced Identificatioi Personally Known ij@pivENS
Type of Identification Produced C-�` 23 Type of Identification Pro m1gs1oN#GGo22023 i
NAS 022 EXPIRES:December 16,207 ?'
Commission No. DEQ6^2020 Commission No. Bonde� Yblteundae+�riten
.•�y,+ e4;,. Rh�`CO �Pbetcae�yntlets
l i yN.� MWwd'Q
' P\Rti Notary U
ADA
smf, Q-
Revised 07/15/201
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS