HomeMy WebLinkAboutBuilding Permit Application _4
ALL NPPINFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ,m Permit Number:
R RECEIVED
Building Permit Application
Planning and Development Services OCT y 1 . Zo1�
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 -
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PROPOSED;INf,PR,ENT LOCATION
Address: r /OL
Legal Description: VA ,v ,r/1 1? z0 t Zi
Property Tax ID#: 2(f z7—7b z-0d 9.?"0CY0-'j RAI ��_ Lot No. Y/9-
Site Plan Name: Block No.
Project Name: SCA04.v /N
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION,OF.INORK
��►'i>hC �- SG�I�Ctiv /N �tiL'/OTt�O�ILG�j G/N •���
CQNSTRUCTION'INFORMATfO.N
Additional work to be nertormed under t ispermit-check all appy:
❑HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
❑Electric ❑ Plumbing ❑Sprinklers ❑Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ �Qd Utilities:Sewer[]Septic Building Height:
0V1/N`ER%LESSEE :`' CONTRACTOR
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Name AM C a Sim Name: /e';P-1n1
Address: Company:SE/Q LevA& G.
City: / L State: Ie l Address: Q fie
Zip Code: ,� Fax: City: IC& �///���Ce State
Phone No. — Zip Code: �y�/19 Z Fax: n
E-Mail: /jOn'/E/li�i�� �[�� /� .�fJt hone No. 7Z u.�� T.13
Fill in fee simple Title Holder on next page ( if different E-Mail:
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SGPPLEMENTAL CbNSTRUCTlON LtE'N LAW INFORMATION,'.
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: 4 . Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: hone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
Cit "T
y: 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
commeoclig work or recording our Notice of Commencement.
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Signature of Owner/Lessee/Contractor as Agent for 6wr Signature of Contractor/License Holder M
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STATE OF FLORIDA g '— STATE OF FLORIDA _ g
COUNTY OF COUNTY OF
The forgoing instrument was acknowledgd before e The forgoing instr ment was acknowledged be'ore&e
this da of ,� 20
y �by this V day of 20 l y a
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(Name of person acknowledging gr- (Name of person acknowledging)
2-4-" -A 91=� §L J 4�;�l 4 4(Z�'
114
( ignature of Vary Public- tate of Flori a) (Signature of Notary 61,
ic-State o orida )
Personally Known OR du ed Identification / Personally Known OR Pr du Identification /
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No.
AUDREYB.HUMPHREY
AUDREY R '* *= My COMMISSION-#-F }7q
:a EXPIRES:March 6,2019
MY COMMISSION FF 174772 a•.Rt
Revised 07/15/2014XEXPIRES:March 6,2019 %�""'�' Bonded ThruNotary Public underwrtem
' � Bonded Thru Notary Public Underwriters
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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