HomeMy WebLinkAboutBuilding Permit Application ALL APPLICAIILE I FF0 MLIPT BE COMPLETED FOR APPLICATION TO BE ACCEPTED Q� _
Date: `-� �� Permit Number: � � I2:2S1 1
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 _X
PERMIT APPLICATION FOR: a
PROPOSED IMtPRcOUEMENT LOCATION:
Address: 1 1 (1 all-fP n
Legal Description:
PropertyTaxlD#: -i��-`�_ t - t` }- �- -` t Lot No. D
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DET`AILED;DESC'RIPTION Q�FWORK
V'L
6,bcy-
-,CONSTRUCTION�"INFORMA�,T�l,GN:
�
Additional work toa nertormed under this permit-check all that appy:
HVAC 0 Gas Tank Gas Piping _Shutters Q Windows/Doors
IR Electric 0 Plumbing Sprinklers F Generator Roof Roof pitch
Total Sq. Ft of Construction: SFt. of First Floor:
W
11
Cost of Construction:$ 1'� J Utilities: _Sewer Septic Building Height:
OWNER LESSEE "`
CONTRACTOR:
Name Name:
Address: �' -" Company: C. `L
City: State: Address: L L
Zip Code:3golL( C\ Fax: City: Stater
Phone No.'-1_I 7_- (6 0 - 53(pc) Zip Code: �? GI�'Z Fax:G
E-Mail: Phone No t�Z -I-(W_9jz!
Fill in fee simple Title Holder on next page (if different E-Mail• YX_14 LIO�AL G)
from the Owner listed above) State or County License: 3017�1Q��
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
6
SU:PPLEMENTALfiCONSTRIJCTLONLL;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%OF
caner/Lessee Contractor as Agent for Owner Sign t e of Contrac o i n r
STATORIDAZ STATE FLORIDA
COUNTY OFSCOUNTY OF C
The forgoing instr nt was a ciowledgeq Wore me The forgoing instrument wa acknowledg d before me
thisof 20 y this ay of 20 by
CK�n o� M '��5 aA-U o"__
(Name of person acknow edging) (Name of person acknowledg' g)
(Signatur r Public-State of Florida) (Si ature of NotaryP blic-State of Florida)
Personal) ""A.''-, R GE u M � tif'Ic ion Personally Know�p.'��
Personally, t�� u�4 -�5gae oTeFloritla ,�" �` NGELA M HUFF
pe of Ide` c •Rrod� Type of Iden�i# ��7?rcloNy
M COMM. " Co ate of Florida
�F oP�,•• y ommExpires Ma 27,�019 '�, .er Commission#FF 2 ��1�
°��t"'� }}'' Commissi ;
Commissi Nd. Bondedthrou�hNationalne��`Assn. .,bRre�;r•• MI.Of""'�piresMay 7 P019
Bonded through National Notary Assn.
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS