HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
_ J,
Newswr 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
PROPOSED IMPROVEMENT LOCATION:
Address: �{jj� i&cG_e�. 1nn� i 5t� rz_ 3Qq�g�J'
Legal Description: illued- 0-C� Vu,; �q - f c"l uC 7B ( I
Property Tax ID #: 3' qZ _I - 5'1b- &0,0t) -co -z' Lot No.
Site Plan Name: A6K4t- Block No.
`
Project Name: 1wYlbr re .
Setbacks Front bl Back: Right Side: Left Side: 20-/
DETAILED DESCRIPTION OF WORK:
G` 14; k &/_-" 01 z �QAes, e3� c rr
CONSTRUCTION INFORMATION:
Additional work toa er orme under this permit - check a appy:
ff
HVAC Gas Tank ❑Gas Piping _ Shutters a Windows/Doors
11 Electric ❑ Plumbing Sprinklers Generator Roof
Total Sq- Ft of Construction: Sq. of First Floor:
Cost of Construction: $ 1100 - Utilities: DSewer D Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name 4e -,c
Name: �vl: 1� 1 ter .-•
Address: 130 lbaw brr.� a
Company: Ol l2J'4wg re-,ce 44r5Ah-S �
City: State:
Address: 4M6_11 51)
Zip Code: .3M3 Fax:
City: &State: At"
Phone No-
Zip Code:, 3V'7f3 ^_ Fax: 16,5-1,40 �J
E -Mail:
Phone No.1,? 7�xS�'
Fill in fee simple Title Holder on next page 4 if different
E -Mail:
State or County License: CSG -��6.3
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applica
Name.--
Address:
ame:_Address:
City: (Jj Iti State -
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone,
MORTGAGE COMPANY: _ Not Applicable
Nam�!A_
AddrCity: State:
Zip:one:
BONDING COMPANY: —Not Applicable
Name:
Address:
City:
Zip: Phone
-
i certify that no work or installation has commenced prier 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 €oliowing building permit applications are exempt from undergoing a full concurrency review: room additions,
accessary 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
commendn work or recording your Notice of Commencement.
Signature of Owner/ Lessee/Agent
STATE OF FLORIDA
COUNTY OFut c
The forgoing instrument was acknowledged before me
this Ct_ day of 20 J'1 by
(Dame of person acknowledging)
(Signature of Notary Public- State of Florida )
Personally Known t� OR Produced Identification
Type of Identifrcatior[ Produced,...
Commission Nci'k "' Uel
(Seal )KIRK ARI KA
MY COMMISS(QN #Fi
Re-Osed 07/15/2014 Lf 2 398-0153
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
COMPLETE
INITIALS
_ S
Signature of Cantractar/License Holder -
STATE OF FLORIDA
COUNTY OF_5/Gt 'e
The forgoing instrument was acknowledged before me
this _!l day of ,,, 2017 by
{ ame 0 person aeknawledging )
Sina ur��
i g a6a��ry/2�_ Public State of Florida)
Personaiiy Known OR Produced Identification
Type of Identification Produced
Cissinn N{ o"'Y`44
0L --
K ARI KATZ
EXPIRES �iixJust 12. 201
SUPERVISOR I PLANS i VEGLTAI-IOM SEA TURTLE MANGROVE
REVIEW REVIEW i REVIEW REVIEW I ftEVlI1A#