HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATIONTO BE ACCEPTED
Date: l�. l �.'Ol�o Permit Number: rn
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-Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300.Virginia Avenue,.Fort Pierce FL 34982
Phone:.(772)46271553 Fax: (772)462=1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: �J S O CVLsy1,1�� i 2r Com, �1 34 q Z}
Legal Description: y cn. Ug • 37 oc') LQ 47- /S30 - L1.9n
PropertyTaxlD#: a3a-�}-(00 )-���ol y�00"JT Lot No. 02
Site Plan Name: Block No.
Project Name: �(e����1 Vy G-L�.2►�'
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
�J yt 1 d JJL ,% (;f 0 o yL 0 0 I,O 12►A
LC61\1STRUCTION INFORMATION:
Additional wor to be nertormed under t ispermit-check all=apply:
HVAC Gas Tank ❑Gas Piping —Shutters Windows/Doors
OElectric O Plumbing OSprinklers _Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: Sewer Septic Building Height:
OWN ER/LESSEE: CONTRACTOR:
Name ,,//�� Name: I�' i G\Y" of n as5�
Address: '(-33( -h W) F�t�l• .Company: syA\&4 --LY S,�-
City: Y e-(`CQ_ State: Address: _:�,\OQ V\w�
Zip Code: Fax: City: e rC.e__ State: 1\
Phone No. `7'Z Z- L 6z) E- Zip Code: � �5 Fax: -71 -!Ste]
E-Mail: y e0 Sft A 2t a 0 Itit/LI 1- 0�0W! Phone No. -1 -1 Z- -7,9 114-)'S7 :9 1
Fill in fee simple Title Holder on next page(if different E-Mail: c�V�-�turvicaYtfS�1 U� �Pa^51 nG �'lD}�n l'CO�
from the Owner listed above) State or County License: C �J Q L
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:
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.
s
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of ontractor/License Holder
STATE OF FLORIDA �1��� STATE OF FLORIDA � L
�G`�—
COUNTY OF COUNTY OF
The f rg instru t was acknowledged before me The r of instr ent was acknowledged before me
this day of 20��by this 1 _3 day of 2k by
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� LIM L\r� Ulm OanlaaaQl
(Name of.person acknowledging) (Name of person acknowledging)
(Si lic-State of Florida) (Signature of Notary P lic-State of Florida)
Pers II Known O Produced Identification P sons OR Produced Identification
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^ `•4PRv oV�ii �, ' :" Notary Public_ OFF
'r�` +`�L Notary ANGELA MHUFF �� = ". ,• Co State of Florida eal)
Co M p= Y Public-State of Florpp ) C M mmis� __ 34730
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m;i ss;on 23 °�Ifo%% Y Comm. ire
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MY Comm,Expires FF 4730 Bonded thro Mh Expires May 27 2019
arYAssn.
Revised 07/15/2014 Yasin `�
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
BATE
COMPLETE
INITIALS