HomeMy WebLinkAboutScan0086ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date.._ j('.�.,ea � � Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1.553 Fax: (772) 462-1578 Commercial Residential'
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: r'��'j°cl 4_, p�? 0a k n r'ie,
Legal Description:
!� y r �'- r � "� O'CA-- `" ritT- ' Lot No.49
Pro rope lax ID #:
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK l
-�,-
CONSTRU�dON INFORIVIATIOM.
Additional work to be ertormed under this permit —check all h apply:
NHVAC E] Gas Tank Gas Piping Shutters n Windows Doors
LSI Electric ❑ Plumbing OSprinklers 01enerator 1:1 Roof I l Roof pitch
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction: $ i3tilities. Sewer a Septic Building Height:
OWNER/LESSEE CONTRACTOR:
Name �'�-C"i Name.
Address: 0, Company: r- Ck r y--,
J•
City:- t ' j State: Ems, Address: 't i_ D r`t i� #ale 11)
Zip Code: �,+�€ ?; Fax: }
City:' `� State
�^
Phone No. Zip Cade: . ,' Fad -11221',-_)9— -_)9— SC17
E -Mail: Phone No. i 2r~s
Fill in fee simple Title Holder on next page ( if different E -Mali: to <i;U C)'6cl
from the Owner listed above) State or County License: L , ! 1 LA i L4
4f value of construction is $2500 or more, a RECORDED Notice of Commencement is required,
5UPPLEMENTAt; CONSTRUCTION LIEN:LAW INEORMATIO-M
DESIGNER/ ENGINEER:
_ Not Applicable MORTGAGE COMPANY:
Name:
Name:
Address:
Address:
City:
State: City:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Not Applicable BONDING COMPANY:
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
1 certify that no work or installation has commenced prior to the issuance of a permit.
Not Applicable
State:
—Not Applicable
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 recard44F vourN"btice of -Commencement.
Signatu/redf OGrner`/ Agent/ Lesse&-�� r` Signature.of GontractorJLicense Hol
STATE OF FLORIDA _ STATE OF FLORIDA
1COUNTY OFt _ �;[ Cj L COUNTY OF = L
Ther in instn int was acknowledged before me ihe. ping in n t was acknowledged before me
this ay of � 1G�.�1 LS)� 20 I try this day of C 2Q ,by
(Name of person acknowledging) (Name of person acknowledging)
(Signat Lf Notary Public- State of Florida) (Signature f Notary Public- State of Florida)
ally Known r/ OR Produced Identification Personally Known V OR Produced identification
Type of Identification Prod Type of Identification Produced
P L E HAMILTON LYNl�BTT siorAiMiLl
Commission No. Y� Commission No. Stjozns
INi SIGN p FF448668 January 2020
EXPUZES: Jammy07, 2020 V F.XPIRE5
Revised 07/15/2014
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
COMPLETE
INITIALS
SUPERVISOR PLANS VEGETATION
REVIEW REVIEW REVIEW
SEA TURTLE MANGROVE
REVIEW REVIEW