HomeMy WebLinkAboutProduct Approval All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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:
Address: in C� -
Legal Description:-j IttPC1C Ve-U li--- I-'bl{c 01 L.Df L (GV- 3`r:`ll--�AO)
Property Tax lD#: H ILA-1O I-0052-co -A Lot No. L_
Site Plan Name: . 1�`•yd'} Block No.
Project Name: Su, Anne I iceCz
Setbacks Front_ 4 Back: Right Side: Left Side:__7C
rr1S}all Dike Col- like anraoe door
Additional work to be pertormed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters ✓Windows/Doors
Electric v Plumbing _Sprinklers _Generator Roof
Total Sq.Ft of Construction:,' Sq.Ft.of First Floor:
Cost of Construction:$ 2,►�20-� Utilities: —Sewer _Septic Building Height:
Name Tff1r1i5I tl�Qflllffi }�-cOn Name:_ ��luj�( 11 ,
Address: I l-i - f'rec;e;
QLI,�_�rlYlSfiflC] C#- Company: IYlm E nse �' $rc fA, }�. �-"„Q��r2e,.i
city:_ Fvi-+ ) itirce State:LL Address: 005 7o•r7a;,.Qlr 'Df
Zip Code: �LAO Fax: ►qN City: J^dinn 44cbm- Ge.ch State: rf
Phone No. t��,1�2��-11Lo�J Zip Code: 32937 Fax: 3L1-777- LIZ3c1
E-Mail: M 14 Phone No. 772-337-4(g70
Fill in fee simple Title Holder on next page(if different E-Mail: (u s5 aun khoo a�
from the Owner listed above) State or County License:
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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.
_Signature of Owner/Lessee/Agent Signature of ontractor/License Holder
$ II
STATE OF FLORIDA STATE OF FLORI A
COUNTY OF ,�QYC� COUNTY OF &f jyd
The forgoing instrument was acknowledged before me The forgoin ' as acknowledged before me
this_I'day of 20 VL. this I y of C>V 20 I,by
am� ers a ed n ) a e of e o n¢wle }
i
Si ure f o of Florida) gn to e f r t Florida)
P ally K roduced Identification Pe o II duced Identification
Ty denti ation Typ d 'fication Pr
��BR�OI�S�tiETI Commissio n'� SZIGETI
Commis' o. MY16�I 0SICI,4rFF244; LJ��Py: ( NAtISSI�ONOFF244655
EXPIRES June 25,2019 "C�'P' EEXPIRES•June 25,2019
P; 9on*d Thru Lb P F
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
BATE
COMPLETE
INITIALS
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