HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABL O M�UjS B COMPLETED FOR APPLICATION TO BE ACCEPTED ^ /
Date:—/ '/ Permit Number:
�s
INS, 111ME
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 11111PROVEIVIEUTLQCATI,C}�1
Address: 1-m— 46-a b
Legal Description: C>C DV�/A 4�,_AT-t4- r-C-WV6b I)A/lrt GID 5 A-A 19 UI-'41/10/
Gni►n��N L-Lc-
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Property Tax ID#: L�/�'(� SJ `� �c�o92 �c9L) -'g Lot No.
Site Plan Name: / Block No.
Project Name:
Setbacks Front Back:/✓ Right Side: Left Side:
DETAILED DESCRIPTION;'OF WORK]
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m
V4Z(TZ7y)
CONSTRUCT[QN INFORMATION ;
Additional work to e e orme under this permit—check a appy:
HVAC Ei Gas Tank Gas Piping _Shutters ,.Windows/Doors
11 Electric ❑Plumbing Sprinklers E Generator FIRoof Roof'pitch
Total Sq. Ft of Constructio=90L
S Ft.of First Floor:
Cost.of Construction:$ O Utilities: Sewer Septic Building Height:
OWNER/LESSEE
Name Name: lmTEhqtEL C,)Q Q lA)
Address: N WV0a Company: tO ,sr / (��INL►r`t.
City: IM Stater Address: 1-7-&� AJLtl
Zip Code: 06611 Fax: City:Sh)Ax�,v Stater
Phone No.('4n3 g Zip Code: ?g99EJ Fax: 6°12-UW17Ky
E-Mail: Phone No. coq Z —OCA o
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: C61f /.15L/
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
S.l1PALEMENTALCQNSTRSUCTIQN LIENtLA1N 1NF4RMATI�Ntj� t
�
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 thepermit 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 Flori Building Codes and St.Lucie County Amendments.
The following building permit applications empt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,f ,w Is,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Yo fa' ' o ecord a Notice of Commencement may resu in ur paying twice for
improvemen your p per tice of Commencement must be rec rde a sted on the jobsite
before the rst in p ct' n. I i end to obtain financing, consult wit en er attorney before
commen In wor r e i ur Notice of Commence
s
Signature of O ner/Lessee/Co acttasAgentfor Owner Sig 'ture Contr or cense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 5-r kllCI.E COUNTY OF -G7-
The
%The for o' g instrument was acknowledged before me The forggooiing� instrument was acknowledged before me
this En of � �T 20 j�by thi��day of SEAT 20/ by
A// ����� /�/�� L1�lA� flC~ ��Z_
(Name of person acknowledging) (Name of person acknowledging)
(Signature o otary Public-Sta a of F orida) (Signature o ry Public- a of Flon a
Personally Known Jz�_OR Produced Identification Personally Known��OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. Commission No. (Seal)
ANN M.GAUMOND
MY COMft41SSI0N#FF 173907 ANN M.GAUMOND
71907
sa;•• EXPIRES:December 7,2018 _'*;
MY COMMISSION 0 FF I
" Bonded Thor Notary Public Underwriters 'H. P: EXPIRES:December 7,2018
Revised 07/15/2014 Af 14' Bonded ihru Notary Public Underwrders
Pa i
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS