HomeMy WebLinkAboutBuilding Permit Application i
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED f
Date:
9 I 2-24 t� Permit Number: I Lot o-
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
PROPOSEDIMPROVEMENT LOCATION
Address: - 103 4_VY1 �z Pl i:zc� L 3,qA�g2
Legal Description: LOT 33 6u-- VI I W bI A-) 1�1 V E l-
Property Tax ID#: 1goa-(ooq- ma -oco- 4 Lot No. 33
Site Plan Name: L-4
Block No.
Project Name: L f 1-o 0
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
I
-C
ONSTRUCTION .LNFORMATION
�.
Additional work to be nertormedd under this permit-check all app
HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
I
_Electric Plumbing Sprinklers E Generator a Roof 7_1 Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:1
fn Cost of Construction:$ Zt.��O • Utilities: Sewer Septic Building Height:
I
OWN ER%LESSEE "CO.NTRACTOR
Name L1400 -S"QE_` Name: _rt Ask'iso A3
Address: (el,o3 z SCZvi- Company: X—f2Lt.LM LOtNlbOujS 4- 'i�)ooe-S
City: :--- t FzC-t State: Address: L{$UD _W S( Si. L 06
Zip Code:341 f Z Fax: City: 4')loyt E_ I State:l=L-
Phone No. -1^1a-���- 33d Zip Code: 3331y-- Fax: Qsq_L-Ti-S-11"I
E-Mail: Phone No. Q'S - (o&j'--t SL�'
Fill in fee simple Title Holder on next page(if different E-Mail: ObLlr lc' '` 60e .9 wgn ' Cor✓1
T
from the Owner listed above) State or County License: ('yZC 13210 Ck S
i
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
I
SUPPLEMENTAL CONSTRUCTION LIEN N
LAW INFORMATIO :
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: ne: Zip: P e:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: city:
Zip: one: Zip: Ph
I
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 ari'y 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
Signatu a of Owner/Lessee/Contractor as Agent for Owner Signature of Contractol/License Holder.
STATE OF FLOIYDA STATE OF FLORIDA
COUNTY OF u s X2-7 COUNTY OF &2.ocy A4_Z-
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thisZZ''dayof Sterir 6U_ 20 14-by this2''Adayof 20 1(a by
I
L'4 a�► s L��� 1 �v�o�-�l I7�o•�A !.�S a .
(Name of person ackno ledgin (Name of person acknowledging)
(Signature of otary Public-State of Flo a (Signature of N tary Public-State of
Personally K f Personally Kno
Type of Identi c n uce Type of Identif ca,jglyfrgduce hRRIE CffRS`�pf
�2 :O�p `BCL
rte= -=n *4- 57
Notary Public-Stat of Florida _ Notary Public-S Florida
Commission `�` + m.Expir }15,2017 Commission zN" "Q: m.Expire 5.2017
.: .„ o-A,-
�''�;o F F Commission#FF 8506 Commission#FF 8506
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
i
I