HomeMy WebLinkAboutBuilding Permit ApplicationMLL HrrLILAU I: INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development5ervices
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1575 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEME T LOCATION:
Address: <3t
Legal Description: Y 1,4Q�'_ (V`C' ~Uf)ftS KhC 4__S Ls3ti,4
Property Tax ID #SQ 19 Lot No.
Site Plan Name: Block No. '-4�
Project Dame:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCflON INFORMATION; - -
Additional work to-beaerforrried_GriJer this perrhit — check all appy
�7IHVAC _-1 Gas Tank E]Gas Piping Shutters
1 11 Electric LJ Plumbing Sprinklers Generator
Total Sq. Ft of Construction:
Cost of Construction: $ S5*0 '�"
5 Ft. of First Floor:
Utilities:[]Sewer ESeptic
OWNER/LESSEE:
Name
Address: 1'23Q NF-
city.
'1>)FCity: s W'A c ct . ( �.,k6e State: r'
Zip Code:a 53 Fax:
Phone No.
E -Mail:
Fill in fee simple Title Molder on next page (if different
from the Owner listed above)
11 Windows/Doors
F1 Roof
Building Height:
�1
CONTRACTOR:
Name: Thseph -rulkf
Company: C Pne'3-i S lAum6t'eie ct-S-rnC'
Address: fta S>✓ Amp—
city: Cdr st, l_Oc kf- State: FL
Zip Code: 3qq,5,z Fax: -7?Z' 3K -
Phone No. 1"12— 39?-- 3GS
E -Mail: Gerw-5ls {plot'' '2�t
cldtc2S .�fr4Ui I .l'.C}i �n
State or County License: i -k
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 Countyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in contlict 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 yo.14r.Ngtice of Commencement.
.mature of Owner/Less ractor as Agent for Owner
STATE OF FI_ _
COUNTY OF C�
The for oing in ent was acknowledged before me
this day of� Zpr-(Q by
(Name of person acknowle ging }
(Signa re of Nota�A7OR
Public -tate of Florida }
Personally Known Produced identification
Type of Identification Producei
i MARIAH MILLS
Commission No. ( ly(�jssion#FF023763
=g = xpiies June 3, 2017
I Bgi7ed Thor Tmy Fain Insumuc 8093857019
Revised 07/15/2014
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
COMPLETE
INITIALS
mature of Contractor/Licensti er --�
STATE OF FL DA
COUNTY OF . ( S,� f -
The forgoing imtWment was acknowledged before me
thi day of 20L by
A
(Name of person a knowledging }
lignatof NotaryPublic- ate of Florida }
Personally Known OR Produced identification
Type of identification Produced
M RAH MILLS iL
No. �scion
Commission! " f .a` (S� H 3. 2
txpiles June 3, 2017017
u 5e^firi",a[fay Faininsurvuat'j.:5;Otcl
..�.� n.
SUPERVISOR 1 PLANS VEGETATION SEA TURTLE MANGROVE
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