HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED J /�
Date: 9.11" .Ize Permit Number: / �7 • 04
RECEIVE®
Building Permit Application
Planning and Development Services SGS 0 6 20��
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
PROPOSED IMPROVEMENT LOCATION:
Address: 1 �o S a�� S� • ��r ; eY ce F1 3�IR�Z
Legal Description: CSL Go P-041-R SI 9 6L1% Z (-fes" I Cit 3le,bb-- Z'W
PropertyTaxlD#: ''tL41'9 - Goa, 0043 - 000 — I Lot No.
Site Plan Name: 1p Block No.
Project Name: 1 Q r ►'LAI.►�'�l� Z
Setbacks Front Back: Right Side: Left Side:
� DE'TAI'L'EDDESCRI"PTION,O'F-WORK: ,
N S`APs
110 4p8 hin�S
CONSTRUCTION INFORMATION:
Additional Work to be ertormed under this permit—c ec a appy:
OHVAC Gas Tank E]Gas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing O Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ a, 3 7 �o'D Utilities:Sewer Septic Building Height:
OWNER/LESSEE: - CONTRACTOR:
Name Ir i o, er7 C ekfName: M i r 1 q
Address: Il (aS)-'�Q)q Company: VoTn JAul^ri e4we S Nuit �,5
City: r"r 'kY'c-e State: Address: 3100 Al 43 14' �-
Zip Code: y'q18 2-- Fax: City: • 1,\2 rc e State: Y/
Phone No. 1?"Z=q`l b-- 16 J!� Zip Code: Y S D Fax: ?72 —1S`ID
E-Mail: Phone No. 772— 779 —1-S B
Fill in fee simple Title Holder on next page(if different E-Mail: (AVWkJAJ'iColh�Sln
m
from the Owner listed above) State or County License: oZ � 3 1 V
IL:e 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.
O�Yv' s
S'A
Signature o wner/Lessee/Contractor as Agent or Owner Signature Contractor/Lic nse Holder
STATE OF FLORID ,;; " : STATE OF FLOq1
RI ":* l
COUNTY OF OUNTY OF
The for oing instr ent was acknowledge fl before m g he forgoing instrument was acknowledged before
this day of 20 6 by his_A day o�,,[7� + ,20 ekby $m
MJ e I a-SS' - S e m rn�m
(Name of person acknowledging) gA.a.�'7 j Name of person acknowledging) �,�
• oil
�A 9 �AJy
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(Signature of V
tary Pubic-State of Fforida) V IS1gnature of Novy
o Public-State of Florid )
Personally Known "" OR Produced Identification Personally Knowr)/ OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS