HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED \
Date: ��9- /(o Permit Number:
� 4 RECEIVrD SEP 09 7016
Wig.Ili =
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
PROPOSED IMPROVEMENT LOCATION:
Address: 730(p N V YoAour
Legal Description: YA.-bOLAr Z)-Olaf PIA,+
Property Tax ID#: K9G-6a 00- 0007— 000- l Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:- ',
boor
CONSTRUCTION INFORMATION:
Additional wor toe nerformed under this permit-check all t=appy:
E1HVAC Gas Tank ❑Gas Piping _Shutters El Windows/Doors
11 Electric 0 Plumbing Sprinklers ElGenerator 11 Roof Roof pitch
Total Sq.Ft of Construction: SFt.of First Floor:
Cost of Construction:$ /�1 - lJL/ UtilitiestSewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Name: inn;
Address: JgR Aw k&Lkour F2;di.e 31y0/' Company: s+ i rS LLC-
v�
City: State: Address: /?17 S
Zi p Code: �r dgQ Fax: 41 City: erg' S4• "de e State:-L
Phone No.(?zp) 33('9-1my Zip Code: 29WO Fax:
E-Mail: AZ Phone No. 7 - 9(p
Fill in fee simple Title Holder on next page(if different E-Mail: J9 pD r �Gt 4 l��V Qy0. COrv�
from the Owner listed above) State or County License: Igs y
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTALCONSTRUCTION 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
commencing work or recordiw,,your Notice of Commencement.
Signatur , f Owner/Lessee/Contractor as Agent for Owner Signatufe of Contractor/License Holder
STATE OF FLO ITA STATE OF FLORIDA
COUNTY OF Lucy COUNTY OF Oji•LJc'N
Thef going instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20\CO by this day of RA 20 by
L a 2Z. 50� �npez
(Name of person acknowl dging) (Name of person ackn wledging)
(Signature of Notary PublkX State of Florida) (Signature of Notary P lic-State of Florida)
S
Personally Known ORP Personally Known OR Pro
Type of Identification Pr �oN 16,E Type of Identification P NAt � 23
M�yp1 S' q�bllcun a :ir::Slci;•.; COMMI inbe16,2020
Commission No. Commission No. 1="5 pcP►(+ ,b%undeWftB
Revised 07/15/201
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS