HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �l O 20 1 le Permit Number:
i
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:
PROPOSED IMPROVEMENT LOCATION:
Address: 1-71 5 E FLo r e��w D2, �oc`r�! Lucy e , FL 3y9k3
Legal Description:
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name: 1D<eS1`v�
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additional work to be performed under this permit -check all that apply:
_ HVAC _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator _ Roof
Total 69 -Ft -of Construction: Z�/OS t -pt c�-r Sq. Ft. of First Floor:
Cost of Construction: $ 27 H L() of Utilities: _ Sewer _ Septic Building Height:
OWNER/ LESSEE:
Name PcCbtcJ -SFE
Address: .506 [ f'14z(,L
City: I-rlA 5t/v\.
Zip Code: $ 7�q&
Phone V46 ) 315 3
E -Mail:
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StatJV�
Fax:
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Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
ICONTRACTOR:
Roof pitch
Name: O i b Ike le /o IPnt'e✓tT_ kou/� i t �-
Company: Teey 4, �A/Ltil �Qk/`
Address: 13c/0
City: ?444 �JL� Stater
Zip Code: 37-9'6 Fax: 3z( 3Z7-£r2/o5
Phone No. 3Z4 509- ?0 i 7
E -Mail: OTD 40eIi fM fs'T00,_�t III- Cd-'4
State or County License: 1 C 0zC/$20 4kq
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
Address:
City:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City: /
Zip: Phone:
Not Applicable
State:
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDINra COMPANY:
Name.
Address:
City:
Zip: Phone:
1 certify that no work or installation has commenced prior to the issuance of a permit.
Not Applicable
State:
_Not Applicable
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. )
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5
Sig ture of Owner/Les a/Contractor�as Agent for Owner Siontractor/License Ider r
STATE OF FLORID /� SLORID
COUNTY OF C7Ao ✓a.2 d' C YL SCJ 2e_,i
The forgoing instrument was acknowledged before me
this _5_ day of 6egte m 6er2. , 20 14, by
%�2/Ly /�/- C.2r nrJiNo/1�rn
(Name of person acknowledging )
ASigAINt�Woure o tary Public- State of Florida )
Personally Known OR Produced I4entification
Type of Identtiitic(atio
G O
Commission No.
roq 4tC AMA
dt�Y P •i min
1 d, NT
Notary Public - State o1 Florida
My Conirg 1}es Jan 26, 2017
;,E �P Commission # EE 861136
"o , :�a` pnnAeA TM1rnnn........ l Nnrary Ian
1
Revised 07/15/2014
REVIEWS FRONT
COUNTER
DATE
COMPLETE
INITIALS
The forgoing instrument was acknowledged before me
this L3 day of=,,7ru¢pi� evnb*t ,20 Eby
(Name of pefson acknowledging
(Sig�otary Public- State of Florida )
Personally Known r dt e l n 'fic ti n
Type of Identification ro{iu
«pyP�a, MEkOBy 61141MNT
Notary Public •State of Florida
Commission No. , My Comm(Wililiis Jan 26. 2017
e',= Commission # EE 861136
.i ,
Bonded ihrnunh National Notary assn
ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
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