HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: /meq �7
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 __X_ Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROF0SE0'111A0i20VEMNTLC+CATlQN p s
ffi
Address: (O ( 00 S �C.CCcr� +Joy- ria7� �uZ
Legal Description: IQ 60 5 (� Cok2=d__N:�Q
C7C,r:►fir"A- S�aT�.1- c�Zy+�, V `'� 702G� ftW12 d NDI k) S( jiLtS
Property Tax ID#: G/�/�I-/���,1 �� OC.for?- U7 C�-/ Lot No.
Site Plan Name:' f-t� �! Block No.
Project Name:
Setbacks Front Back: v4 Right Side: Left Side:
DETAILED bCRIFTlC3N G1Fn WARK' 5
a*-
� 1') 2o��✓Nb s
ys�
GC ;,',TWCTI-
Additi8nal work' tob e e orme un er this permit-check all appy:
❑HVAC Gas Tank Gas Piping _Shutters Windows/Doors
❑Electric ❑Plumbing []Sprinklers Generator _Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction: $ 7 .-wo Utilities: _Sewer❑Septic Building Height:
Name N Name: c
Address: *7c=li?_P Company:
City:� �s State: Address:
Zip Code: 3�(! 17 Fax: City: State: �-
Phone No. 7j2C1 ���( Zip Code: 3 yCj 4'y Fax: G f 7,
E-Mail: Phone No. - QV
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: La cGLl!34-�
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CQNSN LIEN LA1lU INFRM*ATION n
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 thepermit 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 fail to Record a Notice of Commencement may result in your paying twice for
improvements to our op A Notice of Commencement must be reco ded n p ted on the-jobsite
before the A s i pe • n. u intend to obtain financing, c t ith nd ttorney before
commencln rk or ec our Notice of Commence nt.
s
Signatur o Owner/Lessee/Contractor s Agent for ner iSignature of Contractor/ icense Ho er
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF j 1,LrlE COUNTY OF -9Z— X-Or4eE
The forgoiinstrument was acknowledged before me The forgoiW instrument was acknowledged before me
thiV7,-2of201by thi5�sof Q� 20/f by
(Name acknowledging) (Name of person acknowledging)
(Signature o-f-Notary PubTi—c-State--of—Florida (Sign atur f-N ota ryPu bIbIic-Stade of Florida)
Personally Known OR Produced Identification Personally Known V_ OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
ANN M.OAUMOND ;alt eve ANN M.GAUMOND
'* `•*` =*? *: MY COMMISSION#k FF 173907
'"' �' Bond EXPIRES:
:December
,201es 'o EXPIRES:Decembers 2018
_it
Revised 07/15/201 F•••a�• .•.. 2;.
�,,,,,,• ;pf.6 Bonded Thru Notary Public Underwriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS