HomeMy WebLinkAboutBuilding Permit Application A
ALL APPLICABLE IN )O MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: fo Permit Number:WO
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Building Permit Application
Planning and Development Services n
Building and Code Regulation Division
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2300 Virginia Avenue,Fort Pierce FL 34982 �' p(atd K'0_ :1c,
Phone: (772)462-1553 Fax: (772)462-1578 Commercial - Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line roc.-+
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PROP(.}SED,19'RP VEMENT'LQCATION
Address: a
Legal Description: \-h i owQrw- 0� Say ha Club bIL �-I L4, (I
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:SOICUOM
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION (�F WORK A . � � r .. - 3
Qat
CC}NSTRUCT QN'INFORMATZON
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Additional work toe e orme under tispermit—checka apply:T
HVAC 11 Gas Tank Gas Piping _Shutters Windows/Doors
❑Electric ❑ Plumbing Sprinklers Generator Roof 3 L Roof pitch
Total Sq. Ft of Construction: r S . Ft. of First Floor:
Cost of Construction:$ q77 Q Utilities: Sewer Septic Building Height:
01NNER/LESS.EE „' CONTRACT,C3R
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Name Wane Tacjobgs Name:
Address: � W) �. Company: S (-�
City:�1 &i- (AAl;.i,l State: IFL Address: 30 Com trtial
Zip Code: 2q.q'S 2. Fa//x__: City: �A`� Statue: rL y
Phone No. ��C/ ����[p(�/� Zip Code:, q�.1 FF/a�x1: VI -1�,2-'�3
E-Mail: _ 0. 7 L1 Phone No.. r32/ ��� ( 8 1"
Fill in fee simple Title Holder on next pag (if different E-Mail:�►�oVO W SoAns C0�4JUF-f,on
from the Owner listed above) State or County License: CCC 1330_X5
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION 11 EN LAWN ORMATION
MORTGAGE COMPANY: _Not
DESIGNER/ENGINEER: _Not Applicable_ INFApplicable
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
com a ci ork or recording our Notice of Commencement,/
s
Si ure of Owner/Lessee/ ontractor as Agent for Owner Si natur of Contractor/License Holder
STATE OF FLO�DA STATE OF FLORA
COUNTY OF P��"(V COUNTY OF bbYLV
The forgoing instru�yyent was acknowledge efore me The foFday
ing instru en was acknowledged before me
this�day of 5(7( 20 �by this of �� 20 f by
(Name o e son acknowledging) (Name 81f rson acknowledging)
(Signature of Notary Public-State of Florida) (Sig ature of Notary Public-State of Florida)
Personally Known I OR Produced Identification Personally Known _1< OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. �osiraue4 (Seal)PABLOARES Commission No. (Seal)
? o MY COMMISSION#FF 998006 oS�Y Pg.", PABLOARES
* * � o COMMISSION
9'FOFV-,G' Banded Thtu Pudpt Notary Softas N� `ate EXPIRES:June 1,2020
Revised 07/15/2014 �"IF110 Bonded TlvuBudgMNotary SaMms
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS