HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED _ I ��
Date: Permit Number: RECEIVED
Building Permit Application DEC 0 7 2096
Planning and Development Services PERMITTING
Building and Code Regulation Division St. Lucie County, FL
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
PROPOSED IMPROVEMENT'LOCATION .
,l
Address: 3clw f��r/�s�� �GI��Q/7 Ur
Legal Description:
Property Tax ID#: _: uW a q — A0,0 —00aE " 01010 —8 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION O.F,WORK:
Re-MOVE Cxi's-r�n 8a.Atuo ltei'/alce rW"i-A /4Crplic *u�
z
CONSTRUCTION.fN_FORMATION
Additional work toe e orme under this permit—check k a appy:
HVAC Ei Gas Tank []Gas Piping _Shutters Q Windows/Doors
11 Electric L_Id Plumbing Sprinklers ElGenerator Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
.�3A
Cost of Construction:$ �� 00 � Utilities: _Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name N)"CA O/as B a-51 Name: M;0,ACl C0/e/11AII
Address:, dun Ceyi9r' IQ Falcon L)1` Company: -CP`cl /t,tr, 'n Zi C
City: 1;*9I% ' Yr /U Ci @ State:EL. Address: /AO CASr
Zip Code: 57Fax: City: PCK ld� k �0�_ Stater
Phone No. r1�� �� a0�6 Zip Code: _�a-1 Fax:
E-Mail: Phone No. �-S6 N6 7 6 Q
Fill in fee simple Title Holder on next page(if different E-Mail: rA &C 19$0 M ;/ , Co A,-\
from the Owner listed above) State or County License: C G 0 N�00..5
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL`CONSTR'UCTION 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 TITLEHOLDER: _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 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.
_M-r� s
Signa re o L on Tactor as Agent or w —Signature of Contractor License Holder
STATE OF FLORIDA STATE OF FLORID
����
COUNTY OF )(°LE, COUNTY Of
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this IL day of 20 by this day ofDwojoL.20 O by
V-Z�y' cx JY`. I
(Name of person acknowledging (Name of person acknowl ging)
0 AA 0 —
(Sign ture of NotaryPublic-State of Florida) / ignature of N �blliiate r_' aPersonally Known OR Produced Identification ✓ Personally Known Identification
Type of Identification Produced Type of Id n on
:>Q H RYN POCKER
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Commission No.. My COMMISSION##G
(Seal) Commissi '�oaM10•- EXPIRES November 212020
,,.,�a•o�B;,,, KAREN S. NIELSEN
ommission 115637
oma? My commission Expires
Revised 07/15/2014 ' ;; lune 12. 20 a
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS