HomeMy WebLinkAboutBuilding Permit Application 1
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTEDiaa�11
Date: /d- 1 'LA—1Lr, _ Permit Number:
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Building aIrtApplication L9 l �
Planning and Development Services k d k rIt"�
Building and Code Regulation Division �— ?
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax:(772)462-1578 Commercial ®CUf8gWi lal
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PERMIT APPLICATION FOR: Demolition St. Lucie county, FL
PROPOSED IMPROVEMENT hOCAT143N:
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Address:_ ~/`Y �5 LTJ �aur'�)e tJ aye (� , (� -e-,c-e-
Legal
eLegal Description:
Property Tax ID#: o2, (n ` C.oo - CSS Z -�� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILEDDSCRIPTIONOF WORK•
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CaNSTRUCTION INFORMATION ,
Additional work toe nerformed under this permit-c ec a appy:
❑HVAC _Gas Tank []Gas Pi Windows/Doors
Piping Shutters ❑
Electric ❑ Plumbing F-j Sprinklers ElGenerator E] Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
CX
-)O of Construction:$ 2 , CU Utilities:Sewer Septic Building Height:
OWNER/LESSEE• ;' eGONTRACTOR•`' a
Name Name:
Address: ('-l3U IJ Imo. Company:
City: �c�- �� State:7 L Address,: nI U30 �cr�1l 2
Zip Code: 0 '( Fa . City: ��x^� �_ Stated_
Phone No. ?''s'3- Zip Code: 32,401 Fax:
E-Mail: se- z_Et e D2 K'�-`oma ten— Phone No. F)?l- 3 3- 2_(,L 1
Fill in fee simple Title Holder on next page(if different E-Mail: SL L e r-- D (L\I0fzTO-4. �_GY"
from the Owner listed above) State or County License: 01(ZC t3Z'-(Cho
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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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
SigSiggnom of Owner/Lessee/Contractor as Agent for Owner Signature of Contrac or/License Holder
STATE OF FLORID STATE OF FLORIDA
COUNTY OF �Y9-�eQ COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument�was acknowledged before me
this I-V day of cQ�abe� 20((,,-by this I day of CSL erz ,20 Co by
\ef-� &5
(Name of person acknowledging) (Name of person acknowledging---- -
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known Personally Known OR Produced Identification
Type of Identification Pro p ° , Type of Identification P used,
MMISS
p: EXPIRES:February 27,2020 a:*':� ,, DINAPARRINO
Commission No. noa"O�' Bonded(�{ltaryPUNliCUnderwriters Commission No. _,` ts' MYCOM� �#FF 957600
EXPIRES. a ru ry 27,2020
Bonded Thru Notary Public Underwriters
Revised 07/15/2014
i
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION_ SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS