HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED .
Date: Permit Number:
RECEIVTH SEP G 9 2916
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: 170/ NW -7YP'9b
Legal Description: A/Lour beeryinas S V i I I eP Lof ..
Property Tax ID#: YcF(o-93s- 0011 - 400 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:'
71�_eploLc1— Cr?x 7 6-a 6,9e A�vor ; E`� �'o r I'ke
CONSTRUCTION INFORMATION-
Additional work to be ne ormed un er t is permit—check all t=appy:
HVAC Gas Tank ❑Gas Piping _Shutters F]Windows/Doors
❑Electric ❑Plumbing Sprinklers ❑Generator ❑Roof Roof pitch
Total Sq. Ft of Construction: SFt.of First Floor:
o
Cost of Construction:$ 700. p Utilities:1nSewer Septic Building Height:
OWNER/LESSEE: 'CONTRACTOR:
M L4r) *1e'Y�d 9r Name: Jen; Z
' Name r,r, /
Address: 1701 A)V (3 --r+or, %A-S Company: 1P4 CZ011,0 4 wtoP A00/s. LLC.
City: Aaler►n State:je�- Address: 190 JW M it(' E,�, A vP•
Zip Code: Fax: AIZA City:_Art 5, . `L'X,0 State:
Phone No.(-_7702 33 f0"�3S Zip Code:� 5�� Fax: Irl�it
E-Mail: /1144 Phone No. o� 37 /�g/4(p
Fill in fee simple Title Holder on next page(if different E-Mail: Or C_0 r"
from the Owner listed above) State or County License: ��
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 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
Signat of Owner/Lessee/Contractor as Agent for Mner Signat a of Contractor/License older
STATE OF FLO r �c•\� STATE OF FLOR�IDAL�c�e
COUNTY OF COUNTY OF S
The forgoing instrument was acknowleftd before me The(forgoing instrument was acknowledged before me
this 's\ day of SM 5r 201 by this ` day of �Q�' 20�by
Z_
(Name of person acknowledging) Name of person acknowledging)
(Signature of Notary PubliU State of Florida) (Signature of Notary Pub -State of Florida)
Personally Known OR Pr ced Ide Personally Known OR Produc ctidn
Type of Identification Produced A 1eGN 3Type of Identifica ' RIE GIVEN
�e10N# B G. ,••''7V"",, —COMMISSION#GU
Commission No. • &%U ,, MYc �ecem�`� dcwrie'��• Commission No. AIRES: �'
1asYQubticUn d ;q= � taryF} icUndc;will ..:
Revised 07/15/201
u����
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS