HomeMy WebLinkAboutBuilding Permit Application 4.1 .
ALLAPPLICABLE 1 FOM STB COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: I (YYYJJJw 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:
PROPOSED IMPROVEMENT LOCATION:
Address: (4
Legal Description: fm 0 l S c,l:. /�edc �
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Property Tax ID#: ODa S Lot No.
Site
o.Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:-
Oul-brcavl, Uec+Aer%,)% heuke,r c��re, t�p',lr e1ecVn*0_C Q
bCeati c r 1r% -Panel, T.nSiciLo Qsm TroAcc-zon In we 11 arca .
CONSTRUCTION INFORMATION:
Additional work to be nertormed under this permit—check all that appy:
HVAC Gas Tank ❑Gas Piping _Shutters 13 Windows/Doors
_Electric 0 Plumbing Sprinklers El O Roof Roof pitch
Total Sq.Ft of Construction: S .Ft.of First Floor:
Cost of Construction:$ 2!�® Utiiities:llSewer&Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name l � U 3 Name: VYY
Address: Company:Ers+ () mn Flec e nit 9L.
City: t,,►rf 1,e-f-c- ., State: E(, Address:3,55r) 1<J � 19'lP Vl #,��
Zip Code: Fax: city,-.,%m Pn r 1/\ Stater
Phone No. c?3— ` Zip Code: (04 Fax:
E-Mail: A- Phone No.;!�lD 1• Ot 1- (A ED Q l0
Fill in fee simple Title Holder on next page(if different E-Mail• FwA m rcnel erM V a nnal I.00 M
from the Owner listed above) State or County License:
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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 Counter 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.
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Signature of Owner/Lessee/Conttactor as Agent for Owner Signature of Contractor/License H Ider
STATE OF FLORIDA / STATE OF FLORIDA
COUNTY OF ��G l�`e��� COUNTY OF l"L✓! �`e�'Gu/
The fo oing instrum��eggt was acknowledged before me The Ifoing instrument was acknowledged before me
this day of ///d(��o?r,��i20/�by thisday of 20 lei by
(Name of person acknowl ing) (Name of person acknowledging)
(Signaturep otary Public-State of Florida) (Signatu�POfNotary/_Public-State of Florida)
Personally Known_ V OR Produced Identification Personally Known x OR Produced Identification
Type of Identification Produced Type of Identification Produced
Corrin ' MARIA C.VIOLI Commission`N0. ea
c ��,.Y P`,,,� II IA C.VIO
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No Public-State of Flott��a i •1PaY P6;1"
slop+y FF 97710 7 ;_*, *� Notary Public-State of Florida
Comm.Expires -..-Mmission 0 FF 917527
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Re - / through National Notary Assn. ' =;r, My Comm.Expires Jul 19,2020
F Bonded through flatlonsl fictary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
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