HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: t rJ 1 Permit Number: I1 d d�13
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 Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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P,ROPESER IMPROUEMENT LOCATION . . ._ '
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Address: 88.`�n �ikltat "�Udv l orJ
Legal Description: 00
2 fr
TK r2rr ✓E POO o'2 3 3(fr 7 K
Property Tax ID#: 3 (4th —®Ochi OCO/C:::) Lot No.
Site Plan Name: �ne.(1 W,W Block NoT
Project Name: l�
Setbacks Front P A- B ck: Right Side: Left Side: N !a
DETAILED DESCRIPTION OF WORK:..'
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CONSTRUCTION INFORMATION
Additional work toe e orme under this permit—check a appy:
HVAC Ei Gas Tank E]Gas Piping _Shutters LoWindows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction:$ 2 I�� Utilities: _Sewer OSeptic Building Height:
01NNER/LESSEE CONTRACTOR "x'
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Name (J' Name: M(C—I-{^✓IYZ &001'J N
Address- 02,D :8 .v 1'c1N(o.�! I Company: 7E7VSEh!'� AA1t41NL4
City:Yr�(1.�S"t" Lyf.l(_ State:u/ Address: 1'7 Zv NW .622EYLgtv�(�L,�
Zip Code: 3�SJO Fax: City: rL,C� State:
Phone No. Zip Code: qQ Fax:
E-Mail: Phone No. — (01?2—O s�
Fill in fee simple Title Holder on next page(if different E-Mail: Afictb446d
from the Owner listed above) State or County License: YV
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL C(3NSTI2UCTfON LIEN,[_A1N INFC}f7MATION.: '
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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 thepermit 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 f i r Record a Notice of Commencement may result in our pa •ng twice for
improvements to your rop otice of Commencement must be or d a p t on the jobsite
bef t fir_ insp tion tend to obtain financing, consult it I der r a orney before
c men in ork r re i our Notice of Commencement.
s
ignature of Own r/Lesse /Contractor Agent for Owner Signature f Co racto /License Holder
STATE OF FLORIDA STATE OF FLORIDA _
COUNTY OF ()UC COUNTY OF �t2,T L�1`
The forgo' g instrument was acknowledged before me The forgoing instrument was acknowledged before me
thi ��y of 20/Y,-by thg?� a'y of C 20// by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pub ic-State o -Florida) (Signature of Notary Pubic-State-o-f State-o- Florida)
Personally Known_ OR Produced Identification Personally Known ----OR Produced Identification.
Type of Identification Produced Type of Identification Produced
t
Commission No. Commission No. ,
=q�r AN M.GAUMOND si "'y M.GAUMOND
k' MY COMMISSION#FF 173907 '*d :+_ MY COMMISSION#FF 173907
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Bonded Thru Notary Public Underwr ters V',.A \° Bonded Thru Notary public Underwriters
Revised 07/15/20
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS