HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I I
Date: r{'l�� Permit Number:
RECEIVED
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Building Permit Application DEC 0 7 2096
Planning and Development Services
TING
Building and Code Regulation Division Lucie ounty,
2300 Virginia Avenue,Fort Pierce FL 34982 St. Lucie County, FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: zt m /F E04Legal Description:�11 y Awt` G r/ �/`l �L S' e- e e017A0 &12
Property Tax ID#: lRzo 00 0 0 Lot No.
Site Plan Name: Block No.
Project Name: �-
Setbacks Front— o_ Back: j Right Side: _Left Side:
DETAILED DESCRIPTION OF WORK:
Re'movg &ile-efe, AV/— fi et'ri5 let
Z-)
� ,/15
CONSTRUCTION INFORMATION:
Additional work toej performedunder this permit–check a appy:
HVAC 1_I Gas Tank 0Gas Piping 1:1_Shutters a Windows/Doors
Electric ❑Plumbing O Sprinklers E]Generator Roof
Total Sq. Ft of Construction: /Xz S . Ft.of First Floor:
Cost of Construction:$ Utilities:Cn Sewer FiSeptic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name tbut c°5 7 "'5' Name:
Address: ��� .�� �� Z/ 14.V� Company: �Cr�!✓���°
City:r/Z!ga A 6 6ez-� State:_ Address:
Zip Code: *,?3 06 C-) Fax: City: _7X''5, State:
Phone No. gcry 669 y-)oo Zip Code:�;cey- Fax:
E-Mail: Phone No. f�/ G/��✓'
Fill in fee simple Title Holder on next page(if different E-Mail:
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:
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:
1 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
commencing work or recording our Notice of Commencement.
S
_Signature of Owner/Lessee/Agent ignature of Contracto icense Holder
STATE OF FLORID STATE OF FLORIDA
COUNTY OFa.1_!,)(' 1F, COUNTY OF ,c:
The f rgoing ins ment was acknowledged before me The forgoing instrument was acknowledged before me
this T day of 20 (4by this IL day of" 20 L4!�_by
miA r==x bA Inv
(Name of person acknowledging (Name of person acknowle/dging
(Signature of Notary Public-State of Florida) (Signature of Notary Pub ic-State of Florida) /
Personally Known OR Produced Identification Personally Known OR Produced Identification ✓
Type of Identification Produced � Type of Identification Produced �.
Commission No. KA4601)i. NIELSEN Commission No. (Seal)
Commission# FF 115637
* "*� `,�O4p0.TO�Bii KAREN
- ` My Commission Expires
My Cmsion #FF 115637
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poop ,`,ortt° m'sslOn Ex ir`S
12, 201 8
Revised 07/15/201 June
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
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