HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 I i z j 1 I
Permit Number:
B it 'ng Permit A 'cati n
Planning and Development Services
Building and Code Regulation Divisio
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 C011'1l'1'lercia) Re51 a trial
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
I PROPOSED IMPROVEMENT LOCATION: I
Address: a ll Y7 Glcid kst Cc Y"
Legal Descriptions --t :`C� GkUIj - -tj;J [�1yc IC_ ) LC �" )
Property Tax I D #: -�
Site Plan Name:
Project Name:
Setback&cont
`� - 7C1 - --<D1 -7 Q -i-
CA
Back: Right Side: Left Side:
Lot No.
Black No.
DETAILED DESCRIPTION OF WORK:
i
I CONSTRUCTION INFORMATION: 9
Adonal work 6tifIrtormeci under this permit— cn l apply:
diti
HVAC Gas Tank []Gas Piping _ Shutters a Windows/'Doors
Electric LJ Plumbing Sprinklers 0 Generato� E]Roof l� Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ i S-51 �' utilities:Sewer ElSeptic Building Height:
ai �,
OWNER/LESSEE:
CONTRACTOR:
Name L)oadet-sen J Boo � Eeey1
Name:
Company: �Y ay' -h o Ca rozvt'tV_,!-
--
Address: JL9 3 _7 d,�P l c�Ot � t� t r
City: Roy, {- �A-Lo"<_ State: F L_
Zip Code: 3 `i Ci 5 �Z Fax:
Phone No. oZ `� � �'}�}- �
E -Mail:
Address: S
State
City: I — :
Zip Code: 3q Tr; I -S: Fax: 1 124^13-33S j
Phone No. _112, _. -3-2-2-2—
- --2—
E -Mail: jVWk"li_ `� 4 Lc ,.
Fill in fee simple Title Holder on next page (if different
Fill
from the Owner listed above)
State or County License: ciz 1 3 ,
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAIN INFORMATION.
DESIGNER/ENGINEER: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
MORTGAGE COMPANY: M _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address:
City:
Zip: Phone:
Address:
City:_
Zip:
Phone:
certify that no work or installation has commenced prior to the issuance of a permi
St. Lucie County makes no representation that is granting a permit will authorize the permit o er toMui e su lect structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit su(
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 addition
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-res>dential 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. I!you intend to obtain financing, consult wit)oder�or an attorney before
commeocin�kork or recorcNne vour Notice of Commencement. „ /
Sighature of Owner/Lessde/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF
The forgoing instru ent was acknowledged before me
this _[Q_ day of 20 aby
e.
�1'°�,tcut -A-4—
p or,
hpersacknowledging )
(Signature of I - t e of Florida
MICHAEL. GERHART
Personally Kn Wn
Type of Identi i ocl,T
i91r71!f'!•y-7J flur M}�Yri:s y's'rvx:R tan'
Commission o.
Revised 07/.15/2014 0 0
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF �—a
The forgoing instrument was acknowledged before me
this day of20 I by
i zt( . '� 0
(Signature of Notary Public- State of Florida )
Personally Kn rcin Ri31>I eQWF1H Rjior
Type of Identi irk F�;cet�r,+kr.ssl�ry u Fera..
EXP+�E.S May 14..p2001y9 '
Commission T J%� "`'J L,w1ANWi'Y S!'
0 0
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ZONING
SUPERVISOR
PLANS
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SEA TURTLE
MANGROVE
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COMPLETE
INITIALS*
VP
COUNTY
F L p R 'I D A
BUILDING & CODE REGULATION DIVISION
2300 VIRGINIA AVENUE
FORT PIERCE, FL 34982
772-4521553
L-A'
TO: St Lucie County
'r
Permit #
Payments must be received in this department by 4.00 PM for transaction to be
processed that day, if not it will be processed the following business day.
Credit Card Number Li 0,5-1 '5�, uo (0 LS.S (-' i `l
Expiration Date . _ 0,412-0 Zip Code '314c157 Ah
3 digit security codeIMEMIr
44 ount $ + 1.5 a sure arge
Business Ni
Authorized
Print Name;
Phone ( )
Fax:
G�3
Comments:
a
SD Revised &/01120!0 EN!