HomeMy WebLinkAboutBuilding Permit Application i
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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RECEIVE®
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Building Permit Application SEP 2 g 2010
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)46271553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
-PROPOSED IMPROVEMENT LOCATION: p
Address: h!J/C. 3q
Legal Description: M 35 AE 11603.0a VT G'P 3a(p..A3 •r0r_W UD �!L le N z
SW c5 s o t� R w- a.3�AC. aQ,5�o6-1�s1:5�q-alao
Property Tax ID#: 2312i-,318- PM&—ooci Lot No.
Site Plan Name: Block No.
Project Name:
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Setbacks Front i Back: Right Sid : Left Side:
F-DETAILED DESCRI'PTIO�N OF WORK
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Won LOJ 1Krcca- 110Y)
CONSTRUCTION INFORMATION
Additional work to be performed un er t is permit—ch ck all VS�hutyters
HVAC Gas_Tank F]Gas Piping ❑Windows/Doors
Electric ❑_Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: SInSewerEl
of FirstFloor:
r� `�`�-''� Utilities! Septic Building Height:
nCOSt o_5 structio_n.:=$ S�Fa
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Name._AI(L@. G(05)0V n�I Name: pMp-S L. iSQ,
Address: �' ra
Mol Gry.
VA Company: VIOCS&L E&V_ eCt TnC,.
City: Stater Address: fj��j5 cornm�ee�, A14_
Zip Code: 3�'I°�`t�j Fax: City: YQxQ PrASGh State:
Phone No.7) _ v6 � _ Zip Code: �30119(oC) Fax:
E-Mail: _ Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: i1-.U&C.
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN'LAW INFORMATION.:°`
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: i Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
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FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: ! Address:
City: City:
Zip: Phone: Zip: Phone:
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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 aper_ it Will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Associatio 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 he eby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Cad sand St. Lucie County AmeAdments.
The following building permit applications are exempt from and rgoing a full concurrency review:room additions,
accessory structures swimming pools,fences,walls,signs,screerooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice f 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� s
Signature o wner/Lessee/ ontractor as Agent*for Owner Signature of Contractor/License Holder
STATE OF FLORIQA 1n �. STATE OF FLORf�,Aa
COUNTY OF 6G.In IK,I�JCy COUNTY OF
The f oing instr ent was acknowledged before me The fo ing instru ent as acknowledge before me
this ay of 20by this ay of 20 by
is, I
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(Name of person acknowledging) (Name of person acknowledging)
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(Signa ure of Notary Public- to of F o •da) (Signa ure of Notary Public- ate of rida)
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Personally Known R,� � d Identifica ` F onally Known OR r�11110 1 ,Vntification
Type of Identification Prod �L#° �+= - Ty e of Identification Produce K -BRADY
ids - y_Puma tate.ot FI a
Commission N FF 96012 %a + mmisslon N FF 9607
'as+ mission No. + ° S alp
Commission No. F f,d;;:�� �dmm.Ex Ires FeD 1S "•• °FF�q�' C
P y omm.Expire#Feb 15, 20
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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