HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO M ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED c�
Date: Permit Number: `�� \- ���
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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
PROPOSED IMPROVEMENT LOCATION:
Address: FsA owL
Legal Description:
P ro pe rty Tax I D#: 1 D a: -- 5da� d80 �G
Lot No.
Site Plan Name: Block No.
Project Name:
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-c eck all appy:
LIHVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
11 Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction:$ J5 L4 a0 0 C0 Utilities: Sewer OSeptic Building Height:
OWN ER/LESSEE: CONTRACTOR:
Name Name: V'S tel'\, _ \�
Address: `�«- ��-. Company��P%A ! %ASC_
City: 5 ek C)"QTC!Q. State: Address: (LM AF'Csz_
Zip Code:Code: Fax: City: NI Q EU State:R�_
Phone No. 774_- Lfbd l/ Zip Code:, ?c L9 k;z Fax-��J,S A,:��_gYa
E-Mail: Phone No. S_U=c)AC3
Fill in fee simple Title Holder on next page(if different E-Mail: L q Ar'\(v— C ° CV
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. 0� �)
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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: 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 insp ction. If you intend to obtain financing, consult with lender or an attorney before
commencing work recordinlg your Notice of Commencement. lei
s
Signature of Owner/Lessee ntractor as Agent for Owner Signature of Contrac r/License der
STATE OF FLORIDA — STATE OF FLORIDA ,
COUNTY OF .�–�l Q/►'� 1y Q�� COUNTY OF TnOkL2/VJ I U-e/U
The for oing instryAnent was acknowledged before me The forgoing instrument was acknowledged before me
this a�_ day of JI?,�bZq, 20/1 by this day of Lwham 20 L&—by
(Name of person acknowledging) (Name of person acknowledging)
&;__JX0/-, . alc'n �nkAALUk &AblAn "/),�
(StLynature of Notary Public-State of Florida 'ignature of Notary Public-State of Flora)
Personally Known V/ ' OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
r r- �.•;"��P�% BARBARA ANN 1—.*� t.
Commission No. r 1" '�� i5 ,•� ifl�Fnis n NoTE23I .i7 •.••���p�.,�Seal)BARBARA ANN MURRA
Notary Public-Ste a of Florida L `�-; Notary Public-State of FI a
• Comfntulon I-F 231535 my Comm = .• Comml
'.,+ My Comm.Expires Aug8, 19
Revised 07/15/2014 N Am. �l'f,17%C11 eondea thr p o
ouph Natiorial Notary J sn,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
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