HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1t I A;k a 01 LP 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: To Select from dropbox, click arrow at the end of line
Address: �J35�-1- �QriYY1{.�CY �aet 76LA M Q �A rte' 3
Legal Description:
Property Tax ID #: hA4261D —SI0 - 00bQ 1W Lot No. ,P(-0
Site Plan Name: Block No.
Project Name: c nv\3C)V\ 5^1 CA coc<_
Setbacks Front Back: Right Side: Left Side:
DETAILE . DESCRIPTION OF WORK:
Electric
0 Plumbing
u ---
Sprinklers
ILa appiy:
Shutters
Generator
QWindows/Doors
F]Roof Roof pitch
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction: $ 10-100 0•`ft utilitiestSewer 0Septic Building Height:
OWNER/LESSEE:
CONTRACTOR=
Name ► w
Name: V l 11� �IM.� ufd(k IL,
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Address:?�� 1'-e r1 W1e'jt'cr V-OCLC>(
Company; 0fCmrl i'LA "SoIW 1 S
City:'4 lLk V & G State: F.
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Zip Code: 34QQo Fax:
Phone No.
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Address: 1 5LW 7bKW zoack
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City: Jk)f SJ 1,1,m �7fC LP,,II 1 State:`" ,,
Zip Code:..�.� t Fax: 15U - o -M 2- OLeM
Phone No. tLn I - O�-t i�' iUVO
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: L A+li FOR MQ.IO►IUR-Cki C00%tuf
State or County License: FXMMVW1
If value of construction is �z5uu or more, a KtLUKUtu IVotice or LommencemenL is iuquIic .
DESIGNE
Name: _
Address:
City:
Zip:
GINEER: Not Applicable
Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip _ Phone: _
State
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
tate:
Not Applicable
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
commencinl, work or recordio�g your Notice of C-ommencement.
The forgoing instrumen;�wL nowledged before me The forgoing instrument
I7- 1�i 2 ]S2 y �day of
this day of `o , 0 b this
(Na epfpersonackno i "°end'"/Zc. ,UZyj�
Ss o� S af'f R',
191_912ol1_
(S re of Notary ubli St e of Florida )
Per nal y Known �XOR Produced Identification
Type o Identification Produced
Commission No. (Seal)
Revised 07/15/2014
nse Holder
before me
& by
4(Name,oBersonacknowlFpAW
of Notary Publ c, f F orida)
Perschally tnown y OR Produced Identification
Type of Id4intification Produced
Commission No.
(Seal)
s
REVIEWS
FRONT
ZONING
Signature of Owner/Lessee/Contractor as Agent for Owner
PLANS
Signature of Contractor/Lice
STATE OFF
MANGROVE
STATE OF FL DA
COUNTY OFA W1 bo-fti' h
REVIEW
COUNTY OF
The forgoing instrumen;�wL nowledged before me The forgoing instrument
I7- 1�i 2 ]S2 y �day of
this day of `o , 0 b this
(Na epfpersonackno i "°end'"/Zc. ,UZyj�
Ss o� S af'f R',
191_912ol1_
(S re of Notary ubli St e of Florida )
Per nal y Known �XOR Produced Identification
Type o Identification Produced
Commission No. (Seal)
Revised 07/15/2014
nse Holder
before me
& by
4(Name,oBersonacknowlFpAW
of Notary Publ c, f F orida)
Perschally tnown y OR Produced Identification
Type of Id4intification Produced
Commission No.
(Seal)
s
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
I N ITIALS