HomeMy WebLinkAboutBuilding Permit Application ALL APPLICA LE INFO MUJ BE COMPLETED FOR APPLICATION TO BE ACCEPTED ( r7ol
Date: l PermitNumber:
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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: Window/door
PROPOSED IMPROVEMENT,LOCATION;,
Address: ro l7
Legal Description:
Property Tax ID#: �/4 /b -�(Z n? Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK �sdovr2-
�� r ew Of to/'c c, C
Ph9T h(iUk -Cv1d0f" (LIVIP9 A,(9 4Cf)
=CONSTRUCTI'O'N'INFORMATION:
Additional work to be nertormed un er t is permit-check affl5t appy:
11HVAC Gas Tank []Gas Piping _Shutters Q Windows/Doors
11 Electric 0 Plumbing Sprinklers 11 Generator F] Roof Roof pitch
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ �CJi Utilities:cn Sewer Septic Building Height:
OWNER/LESSEE:. . ;.CONTRACTOR: . .
Name Ilona a;,2ri 061 Name: l eyw24aba:5 e),--)
Address:
OLIg/ i rn�C�rrr� Lr� - Company: ,TUU EY.--P1,ir5rf2 _rig C
City: Al L I State: LL, Address: 1201 !b'2W
Zip Code: Fax: City: �& L Stater
Phone No. Zip Code:gyq'3�; Fax: 77Q-Q7/-b377
E-Mail: Phone No. 7 -QCa Q
Fill in fee simple Title Holder on next page(if different E-Mail: 1 �'
from the Owner listed above) State or County Li se: 0-80— I a()(:2
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SILIPP'LEMENTAL CONSTRUCTION LIEN-LAW INFORMATION:
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, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
JL A A_01"X — '-� S
Signature of Owner/Lessee Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF .S`T' LuC,i, COUNTY OF S'7-
The
TThe forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 2A day of JAAJ 20,�by this ZQday of J,4---� 20 7 by
Se tAg_ kvs o'1
(Name son acknowledging) (Name of person acknowledging)
(Sig u e of Notary PublicState of Florida) (S"re o otary Public-State of Florida)
Personally Known -'--OR
-SOR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. �` 1 N"1VJfVblicStateofFlorida Commission No. .►�'��q� N46WAblicStateofFlorida
Joshua Shane AlberlCO Joshua Shane Alberlco
My Commission GG 020879 My Commission GG 020879
Expires 091!612020 Expires 0811612 0
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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