HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED i " �7
Date: `O =3® . 201 Permit Number: (L9 ll
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 lirie
PROPOSED'IMPROVEMENTLOCATION:
i -y
Address:
Legal Description: E19 cN -4,C_Lk k cu y
Property Tax ID#: L-WA, -Om Lot No.
Site Plan Name: Block No.
Project Name: VoC&'e"K �ES�QIvtJ�
Setbacks Front Back: Right Side: Left Side:
7f k444+•
DETAILED DESCRIPTION OF WORK: r yq� '
w�:�, ®weNs �o(C�.t�e.1� as'4�+acti s���tC,�.�s Rasa ��0� c►�►����ilR�1�
CONSTRUCTION INFORMATION:
Additional work toe e Orme under t is permit-check a appy:
❑HVAC E]Gas Tank ❑Gas Piping /'ndows MGenerator
Shutters Doors
11Electric Plumbing ❑Sprinklers • Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor: zas
Cost of Construction:$ Sa,_2A0 ,0 b Utilities: —Sewer Ll Septic Building Height:
t '
OWNER/LESSEE: CONTRACTOR,'- y;
Name%`i,.`�Q %AZ-LkAQE IF-C&6 Name: XJM UkQLS
Address:?aAZ5 . &y,_,)'e eoa) Company: be\
City: V� State: Address.: CkOk'OK,, �M 1Z l
Zip Code: WA% Fax: City:-�ikiE State:FLK
Phone No. '"Z 0 ?5&. . 42 53ej Zip Coder yam_ Fax:'T?Z.7_3Z,ll�T_
E-Mail: Phone No. `TZ2!QZ3Za 4eek2
Fill in fee simple Title Holder on next page(if different E-Mail: jft"aei\4;,ft !!N
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
i
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 thepermit 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.
47
"' nature Owner '' Agent ` ° Signature of Con tactor/License Holde s
STATE OF FLORID STATE OF-FLORIDA
COUNTY OF. t ck4 .,\ COUNTY OF II/A
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of Gby this day of }�v�zm ,20
en 1 y C_ V"
%mef person acknowledging) (Name of pe son acknowledging)
(Si natu of Nota" Pu 'c- tate of Florida (Signature o N tam u i State of Florida
Person y%l�c+ (rti, ✓ r� N A i i ation Personally �`� �" t' 'c ion-
Type of %W } Type of Id e ti ' "� "�E,roduN80TNY W.}
y hr.State of Flerid� ' Notary
Commission N G6005194 Public-State of Florida
i' •�=
CoCommission, GG
mmi i" P;� My Comm.Exolres Se i$*� n Commissi
81111191%° " p �'•' Y omm.Expires Se 17,
Bonded through National Notary As, �'''�°��t�`:��,` Bonded through National No1ar 2020
Aqqn
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
OOM MEE
INI `' r