HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE 1 FOR APPLICATION TO BE ACCEPTED
Date:
J!MCOMPLETED
I Permit Number:
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: To Select from dropbox, click arrow at the end of line
PROPOSED IMPR, ME
Address:
R
Address: 'QU q Mn evN ecz vie
Legal Description: L4Ir�r,, Lu c.as- 110&4 No arse, �O V .130 � o r
Property Tax ID#: S Lot No. �y
Site Plan Name: `` Block No.
Project Name:r8cG j dere d here
Setbacks Front Back: Right Side: Left Side:
DETAILED,DESCRIPTION OF WORK
f t2xi54(45 coo� w 4V% 3L,5-4-6- YJeA n►
Qr�Vo 54.;�IJI•05 . � '0 2 p kr_r,
CONSTRUCTION,,I.NFORMAT ION
Additional work toenerformed under this permit-check all appy:
.OHVAC _Gas Tank Gas Piping Shutters ❑Windows/Doors
Electric Plumbing (Sprinklers Generator Roof
Total Sq. Ft of Construction: ybl;6 Scl. Ft.of First Floor: b 5
Cost of Construction:$ Utilities:n Sewer FISeptic Building Height:
OWNER/LESSEE: ` CONTRACTOR
Name tinea Lank Vhonki Name: ,B(r-A, I Yk env
Address: S369 mo,; e,n(_�a� 10) Company:'TQ-•eas0eoas� 12ao r'-^s
City: Port b� Lye,;ti State:F1 Address: 131 L SW
Zip Code: 3 4 Q S a Fax: N 1 4 City: po r+ 51 L ue-;L State:
Phone No. 1l.\ aDI - 13 q Zip Code: 3c4j114 Fax: -1c) -34.3
E-Mail: N I A Phone No. 17a-3")a-q ?7 b
Fill in fee simple Title Holder on next page(if different E-Mail:74-f ao f %j; LLL o a r cj.1.Coe"
from the Owner listed above) State or County License: CCC f 3-�66 0
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRU.CTION,,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.
3 �
3- ` P v�l 5
_Sig ture of Ow#/Less /Agent Signalure of C tract /License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF s4 Ltw_ e
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this-4_!�L day of :�-e0 20L.1 by this 14 day of 5gj2o - ,20 . I t; by
Yin o Ar Y:,,- � (y\ak a �
(Name o erson acknowledging) (Name of son acknowledging)
(Signure Notary Public-State of Florida) (Signature/of Notary Public-State of Florida}
Personal) Known OR Produced Iden��t4edtititi<<, . Personally Known X OR Produced Identifl(fitti'
�� is 0611 +�f 'j---
Type of Identification Produced aL4ppERT 8�—�� Type of Identification Produced
a �iss1•N°. �r oma`` ...° 9
Commission No. S �' ay 12, 6 °MMISgjo•,��i
( 4 �, 'o lA o Commission No.
Po 122434 = =v*.,F
Revised 07/15/2014 >9�; �oaedmN. • Q�� y9� � ?434
�y�AG°�No12ySeN�m•'o�O�v. �r,oG. r4Jd�alhm .:=
REVIEWS FRONT ZONING SI Oa"6' 011 PLANS VEGETATION SEA TURTLIMM VE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS