HomeMy WebLinkAboutBuilding Permit Application ALL APPLI L Ir MUST IE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date. Permit Number: 0 ! -2a/
Igo
Building Permit Application
Planning and Development Services
Building and Code'Regulation Division
2300 Virginia Avenue,.Fort Pierce FL 34982 t/
Phone:.(:772)462=1553 Fax:(:772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:. To Select#rom dropbox,.click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: rl (,0L1 A-► W�cuk5 aJ I`+. Kerce , R. 3y c?E)
Legal Description: L-A�G�V�O O ��r IL – ylyt i 1 S- GUL LA 2 Lo-r 3 C►'w
l3_ l U C 0 +2 3 Z) I -2o-a-3 7
Property Tax ID#: 3 0 (0 0 S7- 00 9 to - 6 0 - Lot No. 3
Site Plan Name: ` Block No. '4 2-
Project Name: O r0`�
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION.OF'WORK:
S t� S-�/�r✓t� �I'�N C �d� f� CSD IL `+��O S 1�v��'T��.
,CONSTRUCTION INFORMATION: "
Additional work toe e orme under this permit-check a appy:
❑HVAC 13 Gas Tank ❑Gas Piping Shutters ❑Windows/Doors
11 Electric ❑ PlumbingSprinklers .❑Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction: y , 03 Lt• S Utilities:cn Sewer❑Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name 5oLc_ Let,n-e r0.tn Name:_ M;ri Q►r►-I
Address: -1o0 W, 12I SC.L4_. . f Company: VA/.T.
City: 2►^Ge- State:.EA- Address: -3100
Zip Code: 3 �-19S 1 Fax: City: �E�-• P c,CCS State: 1:51
Phone No. ?72 — O Z 8 2302- Zip Code: 3'ASIS I Fax: -7"72-7014-19 910
E-Mail: Phone No. 7Z-- 3 8)
Fill in fee simple Title Holder on next page(if different E-Mail:A V�xy r\CAy12 Sin v„��erS1 r►c`off Yeo t1 .
from the Owner listed above) State or County License: a g 3 9� c9ly
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 re o caner/Lessee/ ontractor as Agent for Owner Signature of Co tractor/License Holder
STATE OF FLORIDA c \ / STATE OF FLORIDA
COUNTY OF c LV���— COUNTY OF a _
The fo of g instr went was cknowledge b fore me The for oin instru nt was cknowledg d before me
thi day of 20 by this ay of 20 by
J'_- — 1% J
la(y� To, UP)
(Name of person acknowledging) (Name of person acknowled ing)
1 � 1
(Signature of Nota P blic-State of Florida) (S' ublic-State of Florida)
Personall OR Produced Identification P son a � en i is tion
pe of Identification Pr Type �•
ANGELA M H r. . o a y
Commission#FF 234730
Com sl untary Public State of F,�o�id� Commis 2�@0I�
T. '' ` `� €x#fres May
Commission#FF 234 %°,�OFF��P��
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Revi,.,,_ 07/15/261
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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DATE
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INITIALS