HomeMy WebLinkAboutBuilding Permit Application J
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED IIj tom-(
Date: ?12/11 Permit Number:
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BuildBuilding Permit Application4 "�0i6
Planning and Development Services PERirjiT-11NG
Building and Code Regulation Division M. Lucie County, FL
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 IMPROVEMENT LOCATION:
Address: O S- 714 St. Fort Ali 1"�/• 3 yq8,2
Legal Description:
Property Tax ID#: 7/2 0.2 19 / b r 2,11 &rD.' 210 Lot No. 3/
Site Plan Name: Block No.
Project Name: W/ sa vg N.1. le t1j/&g G
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additional work to be nertormed under this permit-check all appy:
HVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
ZElectric ❑ Plumbing Sprinklers ElGenerator E] Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ ?.417. /r✓ Utilities:Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name 0T G.ri-ua HdrNa,,ed eZ Name:�b..,as Hos7�ri�/Gr
Address: 3zd,g s`. 7 n s7t zdf 3/ Company: Tl eame, �fGG�s-/GS,✓G.
City:. r�rf P crc C State: Address:
:ZipGode: 3 '/9'8'2- Fax: City: All
4,.�� Stater/
Phone.No. ZipCode:
_33 /J Fax: 30.5'".233 -ls'Z L
.E-Mail: Phone No..3Ds'133 -4-5 L Z
Fill in'fee simple Title Holder on next page(if different E-Mail: Ve4e4e �►c Ari o. �+1tii✓. fires,
from the Owner listed above) State or County License: ''/3d16�ti
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: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: .,, Not Applicable BONDING COMPANY: -blot 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.
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Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF /�Y .-1 COUNTY OF
The forgoing instru ent was acknowledged before me The forgoing instrument was acknowledged before me
this�day of � 20 Eby this day of 5<��g3o 20 /6 by
(Name of person acknowledging) (Name of person acknowledging)
aa-C
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known .,....P,2 Produced Idents Personally Known ! ,••CPN �P�oduc�d��Ft19qy
Type of Identificati �' P5 DIANA LNiA��AE' ? Type of Identificatio
t°My Comm.Expires Sep 19,2018
Commission No. =%' My Comm.Expi[@@s Sep 19,2018 r oCommit�ie®{�FF 135483.
��� CommiNlooil FF 135483 Commission No. '.F„F�. .•
;.•
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS