HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 3 Permit Number:
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RECE1'."-D JAN 13 ?'j`17
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
PROPOSEDIIVIPROVEIVIENT'LOCATfON,
Address: (D IV\ RHOS ?>)lVfP Vercp
Legal Description: 3 009 V'z"z-L -
Property Tax ID#: Lot No.
Site Plan Name: - Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION C1F WORK yy
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CONSTRUCTION INFORMATION ° {°
Additional work toe e orme under this permit-check a appy:
HVAC Ei Gas Tank Gas Piping _Shutters ❑Windows/Doors
❑Electric ❑ Plumbing 11 Sprinklers ❑Generator L_"J Roof l_Z Roof pitch
Total Sq. Ft of Construction: LA lC/IA Sq. Ft. of First Floor:
Cost of Construction:$ ��� �T& • Utilities: Ll_Sewer 0Septic Building Height:
01-
OWNER/LESSEE ' CONTRACTOR ,_
,. _ k . ..:. . . ,.- .
Name Lawrekyvib�l��Ybi✓ Name: KVi-:_-4eyL
Address: W04 ._Th6,M05 'aWg ViAg Company: We:SLOi1 6W-:FVuc
City: F4, QkC'�-e_e_ State:VL- Address: 513- (0Vb+w,ee4;-0 drr, 5a;4e k1
Zip Code: 549 SL Fax: Nip City: c)W;-kip- State:-l;
Phone No. ,7.-2-- LA2.fl , `f3T6Q Zip Code: q L4 Fax:
E-Mail: N IYA Phone No. Z I - z5-1- (07 89
Fill in fee simple Title Holder on next page (if different E-Mail: KV1 w:�(,-:D— we";(V-t: Cc ' iru t•d►�
from the Owner listed above) State or County License: t;( ,-3-3 0-7%5
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. J1
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SUPPLEMENTAL CONSTRUCTION LLAIN INFORMATIO�t
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 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, ns It ith lender or an attorney before
com a cin work or recordingour Notice of Commencem c t.
S
Sign tura oY Owner/Lessee/Contractor as Agent for Owner Sigfiatureof ontractor/License Holder
STATE OF FLORIDA STATE OF FLOWA 1�
COUNTY OF SA'. 1—1.) C:%Q, COUNTY OF (Z Y
The forgoing instrument was acknowledged before me Thefor oing instr ent wa acknowledged/before me
this day of01 20 �by this day of20 (�� by
O J 0 Awor ))10
(Name of person acknowledging) (Name of person acknowledging PABLO ARES
�'v Cfl!IlAlrSION#FF 998
�U/ 1 umm.June 1,200
(Signature of Notary Public-1-Slate of Florida) (Signature of Notaublic-State of FI W
Personally Known OR Pr duced Id ratification Personally Known Y OR Produced Identification
Type of Identification P Type of Identification Produced
•,•;'nr;;;i
DEANNA MARIE GIVENS
Commission No. „ MYQSSION#GG 022023
"�� 16.2020Commission No. (Seal)
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,, EX R .December
%;;oF i���r•'•• Bonded Thtu Notary Public underwriters
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS