HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED p�
Date: �!L)2- D1-7 Permit Number:
•
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)46271578 Commercial Residential
PERMIT APPLICATION FOR: To Select:from dropbox, click arrow at the end of line
PRO.P:OSED IMPROVEMENT-LOCATION:
Address: 1 ,1 P or e___� Ave. % e Y- e 4 9 S I
Legal Description: FR.i r wam �0.5�L70�4' ��0"�e- \ o e-
y T�•o�► ok e w� I o�' 3'�� -'Iqt / i`c to /y/q
Property Tax ID#: 13 o (o - O 05a'-7— 'OoO ` ��•a Rc)LotNo b I
Site Plan Name: oAk� Block No. 3-2-
1
Project Name: l2 Y'A�r�S
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
L,/:F'i O'IJ 0 r Y'% rte" e.
CONSTRUCTION INFORMATION:
Additional work toe nertormed under this permit-check all tba appy:
HVAC 0 Gas Tank ❑Gas Piping _Shutters Il Windows/Doors
1-1 Electric 0 Plumbing Sprinklers F Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ ;R j It 3� 'a (9 Utilities: Ind Sewer 0 Septic Building Height:
:OWNLR/LESSEE: CONTRACTOR',
Name U� S Name: ' ✓tom e was e
Address: LS D!"e_S ve-- Company: ®.VIIIT-
City: State:fL Address: ] �/VO O N riG S �m�
Zip Code: 3 Y15) Fax: City: �r . � r Q-e-c-P State:_Z.
Phone No. Z - 457_2-_70' Zip Code: 3 S ) Fax: 772-?9q-1S%D
&Mail: Phone No. 2L .-79 Lf — /S 9
Fill in fee simple,Title Holder on next page(if different E-Mail: OJkakAy rY,CA 251itA }er5ikltA �7i
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL.CONSTRUCTION LIEN LAW INFORMATION:
4, A -
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 thepermit 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.
I AAA
'Id s
Signatu e o (Y%vner/Ces_see/C&Ktractor as Agent for Owner Signature I
Contractor/Lic se Holder
STATE OF FLORIDA�g STATE OF FLORID
COUNTY OF �lc.`7_ COUNTY OF
The forgoing instrument was acknowledged before me The for oing instrument was acknowledged before me
this-!J5- day of k-e> 24')—by this �� day of�-C_6 20 1:!L by
(Name of person acknowledging) (Name of person acknowledging)
U54na-bre of Notary Public-Stqe of Florida) (Signature of Notary Public-StQp of Florida)
Personally Known OR PJ-10 �pn. Personally Known 'i tl"ype of Identificati n Pr 1AType of Identifica �Fpduged State of
o` ru ' tart'Fu Dec ,�Pav rua��,�' Expires Dec
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Corrirnission No. ?`, °�': m• p 7249 .r. -N* :My Comm �e4 FF 177249
° Com FF 17 pssn•' Commission No. _ '= Assn.
ate° commis aGonatwtaty sq ded through National Notary
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Revised 07/15/
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