HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 12-5 l(p Permit Number: a�►o3�0
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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)462-1553 Fax: (772)462-1578 . Commercial Residentialy
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line C�
PROPOSED_IMPROVEMENT LOCATION:
Address: 12 . (2 .^od1 )8sL, F4-
Legal Description:
Property Tax ID#: SLIM -:570 " 02-37-- 000-e Lot No. 0
Site Plan Name: Block No. /_/0
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
p -1 vas 4nce w 2 SpSre).Of '
CONSTRUCTIONINFORMATION:
Additional work to be performed under this permit-check all that appy:
HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
11 Electric Plumbing Sprinklers Generator Roof Roof pitch
Total Sq.Ft of Construction: SFt.of First Floor:
Cost of Construction:$ 2�9 : o o Utilities:ll Sewer E]Septic Building Height:
OWN ERAESSEt: CONTRACTOR:.
Name tf,45eqQ /i v1 Name: rn n I-e LN-.)
Address: 582. cS LO bauApp W%y\ tTye. Company: A-C W ef201S*C1A:0h
City: q6t, State:�f=, Address: 1 PJ f SO 6U G S-L
Zip Code: 3L I153 Fax: City: /m Cf' State: FL
Phone No. Zip Code: 3 L"/9 4 O Fax:
E-Mail: Phone No. 2 0(- 8'YL/Lt—
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: Ce;C Q1,T? .3-7—
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTALCONSTRUCTION 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.
Sign ture of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA ''��++ STATE OF FLORIDA l
COUNTY OF Uf: GGf G/� COUNTY OF �' � �-Lf CIz?
The fing instruLQent was ac cnowledged before me The forgoing instrument was acknowledged before me
this day of Yr1 ✓' 20 Toby this�day ofCeln b��!20 110 by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known f11 Produced Identification Personally Known AOR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. Commission No. a 1)
LA M.HUNTER ,•I'ava''•,,
Notary Public-State of Florida '2;*P .�`�= Not STELLA M.HUNTER
ORI = *._ 0 Florida
'sN` t _ Commission
Revised 07/15/201 My Comm.Expires Jan 23,2019 #FF 180552
, p GF Fl�.��� �,,FU i F`UP`, My Comm.
Bonded through National Notary Assn. Expires Jan 23,2019
F,ondedthrough 'dlr
ssn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE`
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS