HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:�n 'oC {' I10 (1 , Permit Number: Ul O �J
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OCT 2 7 209%
Building Permit Application
PEF;F!iITTlNG
Planning and Development Services Si. Lucie County, FL
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
P.RaPOSE,D INl '101lMENfi L0"CA11CN
Address: /60 1 rJ- v r/sl
Legal Description: woo / C e/�
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Property Tax ID#: D I ~ �� " � r D� �� Lot No.�
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DAILED DESCRIPTION OP WORK �
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� C�NSTRUCTI�?�t INFORIII[,�TIQN� � � ���, � .� ,.• yi� .
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itional work to be performed under this permit–check a appy:
11HVAC Gas Tank Das Piping _Shutters Windows/Doors
11 Electric ❑ Plumbing Sprinklers I Generator _Roof Roof pitch
Total Sq. Ft of Construction: 1 S
O
Ft
—Ftof First Floor:
Cost
Cost of Construction:$ UtilitiesSewer❑Se
tic Building Height:
OWNERjLESSEE�;, r x CQNTRACTOR w
Kit." r ........ r ,,, ..✓t, x >,3�, .M....., 1
Name . �Q Name:
Address: //2 7/2 db'9 Company: C,
City: t Pl2Cto State:G Addrejss'
Zip Code: / Fax: City: bk 6o oeoe?oS State:_Ja�
Phone No. 9,9 Zip Code: Fax:
E-Mai1:0 011 1 d-eo Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: 3D�v
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
.41
SU,PPLEMENTALC0NSTRUCTIONXIEN LAW INFORMATION'
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPAN : _Not Applicable
Name: Name:
Address: Address:
City: State: City: T 7 State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HO L RNot Applicable BONDING COMPA Not Applicable
Name: Name:
Address: Z4 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 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.
VOL-&a_ (;3; ' -t-A s
Signature of Owner/Lessee/Contractor as Agent for OwKer Signature o ontract /License Holder
STATE OF FLORIDA STATE OF FLORIDA-
COUNTY OF _ tm COUNTY OF
The for oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this�� day of 0[i Q/l� 20 by this��2lay of d(i—�L�'JQ_/►� 20 by
(Name of perso acknowledging (Name of pers ac wledging)
(Signature of NotPub State of Florida) (Signatur �of Nota Public-State of Florida)
Personally Known �//lic OR Pro Igppffgtion Personally Known •✓ OR Produced Identification
Type of Identification P v Type of Identification Produced
c 8150W B.PETAK
STATE QF_F,,ORIDA QS�Y o� NOTARY��IJBI,(,C
Commission No. cel Commission No. o ,�jR
Comm# 304 TATE O IDA
'401E 19A® Expires 10/21/2018 Comm#FF170304
e I'd- txpires
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS