HomeMy WebLinkAboutBuilding Permit Application I
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: `-� oasq
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: To Select from drophox, click arrow aft the end of line G
PROPOSED-IMPROVEM�E�NT-'L'OCATI`ON.:
Address: ®�`���
Legal Description: 10"A lJ a I (C'91 e � ,0 1 �l�w"��tie.•
Property Tax ID#:. 3 0?1 ®o®3— (-D F(D '— Lot No.
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Site Plan Name:` i' Block No.
Pro),eet Name:
wetbacks Front Back: Right Side: Left Sidi:
DETAILED DESCRIPTION"SOF V1/ORI<:.
,.
k� Pa rLaS.0 ,(". 4 6 c C'3 6
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CONSTRUCTION INFORMATION
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Additional work to be oerformed under this permit—check a appy:
HVAC Gas Tank Gas Piping _Shutters I Windows Doors
❑ P g ❑Windows/
Doors
❑ Plumbing . []Sprinklers Generato I Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction: $ Utilities:cn Sewer Q Septic Building Height:
O;WN ER/LESSEE QQNTRA:CTOR:
Name _jCsvy% Name: lac, `, , ✓— �i
Address: ay/ fvvv Company:
City: State:IZ Address: p r
Zip Code:3-3 ()-6 Fax: City: _. '- �`&s L State:_Lz�_
Phone No. CISy—59.3" 96 Ts Zip Code: '�C401 S7 Fax:
E-Mail: Phone No. "7 '120—N—'0117
Fill in fee simple Title Holder on next page ( if different E-Mail: le ln.-NCk Ct fel-,
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 isl required.
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SUPPLEMENTAL CONSTRUCTION :LIEN LAW INFORMATION .1
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: ,, Not Applicable
Name: Name:
Address: Address: I
City: State: City: State:
Zip: Phone: Zip: hone:
FEE SIMPLE TITLE HOLDER: )C Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: i hone:
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 deedfor'any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, int 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 concurrent y 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 nj ay 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 o wner/Lessee/Contractor as Agent for Owner Signature of Contra Itor icense Holder
STATE OF FLORIDA �, p STATE OF FLORIDA
COUNTY OF ��C - J COUNTY OF �!
The forgoing instrument was acknowledged before me The forgoing instrument was''.acknowl edged before me
this day of Q".i6 20 Eby this L day of 20 ( by
N�S �S �� 1, aDSJI{lJP
(Name of-person acknowledging) (Name of person acknowledging)
(Signa ure of Notary Public- tate of Florida ) WAR
No Public-Stat f Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification "**a
Ty of Identification Produced Type of Identification Produced
Commission N Commission No. I """ NA INGRAM
a�, Notarq�; ASHAH RAM ,.•`pr n�
B'' ;2�p 4� Notary Public State of Florida.
Public-State of Florida. mi s Dec 20,2018
my L;omm.hxpires Dec-2f)-.20
Revised 07/ 5- y Commission#FF 1my Gomm Wim
77249 's"r9r �o� Commission#FF 177249
p �, Bonded through National Notar Assn.
f Bonded through National Notary Assn. ` „a ;:°`� y
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS I,