HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MLIST'BE COMPLETED FOR APPLICATION TO:BE ACCEPTED'.
Date: Permit Number: 111 ( I ' 33
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Building Permit Application
Planning and'DevelopmentServices
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 /
Ph6ne:'(772)462-1553- Fax: (772)462-1578 Commercial Residential V
PERMITAPPLICATION FOR: 70.8elect from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Addross: to n ^^II �('`
Legal Description:. 1.�1.
Property Tax ID#: L4y 2P—)-`7QQOMP)- .Lot No..
Site Plan Name: ^ Block No.
Project Nanfe: ���( �y
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: i
Rewlac-�v1 � o cvr� Cp coo all
CONSTRUCTION INFORMATION: I
Additional work to.b ertormed under this permit—check all apply:
HVAC Gas Tank Gas Piping _Shutters Windows/Doors
ElElectric . 0 Plumbing Sprinklers E]Generator Roof `Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction:.$1?, Utilities: _Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR,:
..Name . rn ov�N Name: 0 oad t
Address; Y ' Company: Oc
ity: vY; State. Ad essFl0 Z10 9n4t/Y
Zip Code: 1 Fax: Cit State:.
Phone Zip Code: Fax:
E-.Mail. Phone No l910 . : .
Fill in fee simple Title Holder on next page if different E-Mail:CI:A QnCp
from the Owner listed above) State or County License: ' 1 1_];J� l 1��
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 installatioi-has commenced prior to the.issuance ofa' 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 Horne Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure: Please consult with your Home Owners Association and review your deedfor 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 non4esidential.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.
�z xee, s
Sign re of Ow r s� a/Contractor.as Agent for.Owner signature'o tra License Holder
STATE OFFA STATE O IDA
COUNTY O . l_. uz-yg— COUNTY OF �I.c�Q✓�
The forgoing inst ent was acknowledged before me The f�goIng Inst ent was acknowledged before me
this day of �U 20�2by this (� day of V �l� 20 ��by
P SLE OBEnR-NDER
R nnnL E nnEERRE? ER
(Name of'person_acknov$ g} g MYCOMMlsslu . - (Name of person ackn$k1'er'gl},Y,COMMISSION#FF112175
*k, ES:April 13,2018
* EXPIHES:Apri!13,2018
oFF� IhruBudgQr Bond2oThruBudget Notar/Services
NOF Fl
(Sig ure of Notary Pulili rida) (Si ure of No_ y. bl,ic-:State of Florida):
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No: (Seal) Commission No. (Seal)
Revised 07/15/2014
REVIEWS- FRONT ZONING SUPERVISOR- PLANS -VEGETATION . SEATURTLE MANGROVE-
COUNTER REVIEW, REVIEW REVIEW REVIEW REVIEW. REVIEW.
DATE
COMPLETE
INITIALS