HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �' 17 Permit Number: 1 l
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Building Pe m t ,
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: j
Address: i cJ o A 9 LA" PCf- R_' PD005
Legal Description: t1 lS 1r1 S
Property Tax ID#: �-�� ��} ����- �� (� Lot No.
Site Plan Name: Block No.
Project Name: 1 -_ie1s0x-\
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
aVF-ove. --P-u sAL'L%' CLLU , fc.h ' -�,•� ctcu , k r'&6J Q YV.J
6A-f7 tm6'Ilre SSA 1+- —IdZZ .2o Q.esl!;ko1�-Sl�t�— 1� 15-p5�8 .oq
CONSTRUCTION INFORMATION.:
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Additional work to-bei2erformed under this permit-check all appy:
HVAC Gas TankGas Piping Shutters a W' ows/Doors
Electric ElPlumbing FSprinklers Elenerator Roof
Total Sq. Ft of Construction: , l- `00 S .Ft.of First Floor:
Cost of Construction:$ ,�� Utilities:]Sewer 0 Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name +-e 150() Name: 01rich-hem .
Address: 15b9IJ 749QI161&C, Company: (2 I-s L L-C
City: Q �t l P�frC� State:_?If— Address: 5515 USS, ( !I'e 4 Z
Zip Code: 3�^IRS Fax: City: Vert &A CAA State:
Phone No. Zip Code: V7 Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: GGG 133 001 Oa
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
-SUPPLEMENTALCONSTRUCTION LIEN LAWINFORMATION i{
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLEHOLDER: _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
coflMencing wo k or recording our Notice of Commence nt.
4 �' H ,
s
nature df Owner/Lessee/Agent S" nure Contractor/License Holder
STATE OF FLORIDA SLC_ COUNTY FLORIDA s jt
COUNTY OF c�l�l� lk�
The forgoing instru ent was acknowledgej,before me The forgoing instrument was'acknowledged before me
this _^ day of 20l/by this lb day of Ja-''` 20 by
(Name of person acknovu gelh (Name of person a a "P
if
MY COMMISSION#FF125420 ) SONIA DESTAFNEY
MY COMMISSION#FF125420
EXPIRES May 21, 2018 EXPIRES May 21, 2018
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407 398-0153 FloridallotaryService.com
(4071 ncmnisi
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(SIJOat re o a)4, ublic-State of Florida) (Si to e o otary Public- a e or rlFlarl_
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Personally Known OR Produced Identification Personally Known__�,�dR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION, SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS