HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �`!l� T' Permit Number: V)
R E C E I D J41 10 ;117
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_Pxl
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line 40
PROPOSED IMPROVEMENT LOCATION:
Address:r163(-
(�re2v��vY iecr L+If
Legal Description: 40D in RQ-K
Property Tax ID#:,332-1-- `700 Lot No.��
Site Plan.-Name: Block No.
Project Name: �5�`@
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to be nertormed under tispermit—check all appy:
HVAC Gas Tank []Gas Piping _Shutters Windows/Doors
Electric Plumbing Sprinklers I Generator 11 Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ ZYUD Utilities:0Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Name:
Address: 7fo3fg. Company: C_D(Z.
City: f 54- State:F-4— Address—;7-3 bOP-L;A �
Zip Codet3 q'(gj=� Fax: City: S'-v State:
Phone No. �7Z 3 ' 7 � Zip Code:,r3L('PT'f Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: c-C-(,15kil S , C-c>'vz-N
from the Owner listed above) State or County License: �-�$63
L ,c_ I.S-0cl
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: lot 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 recordi our Notice of Commencement.
s
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF_ KW-n COUNTY OF M ct6 n
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this T day of'he ctrnbe.,r 20 Eby this=day of'Kr.Ce m bel 201 LP by
(Na of person acknowledging) (Name of person acknowledging)
%'L dot/
Ay
gnature of Notary Public- ate of Florida) nature of Notary Public-S�tate.of Florida)
Personally Known OR Produced Identification Personally Known �,OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No.iti131 OAR (Seal) Commission No.������.3�-P (Seal)
exSHAWNA HODGE SHAWNA M. ODGE
NOT _hW NOTARY PU C
STATE OF FLORIDA au
STATE OF FL RIDA
Revised 07/15/2014W10C FF131836 Comm#FF131
ExDI 1,1111n,10 Expires 6/11 018
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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