HomeMy WebLinkAboutpermit application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: '2)--17 ))7 Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce Ft 34982 p
Phone:(772)462-1553 Fax: (772)462-1578 CommercialResidential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of tine
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Address: !3900°l'13(og8 - Legal) -Tndro Rd �iKf ' Fortii'erCe, �
Legal Description: (S-eQ a)-),*ched)
Property Tax lD#: 11 111 ' DO Da " //.5 Lot No.
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Site Plan Name: cJ7`Pmj r�" I" 1126-1 a l.S ( .
�19 ;r,2,, _ Block No.
Project Name: c kWo rte'f Ma k r"i A 1 S -,pX.,a
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Setbacks Front ' Sack: Right Side: Left Side:
❑IiVAC �Gas Tank Gas Piping _Shutters Q windows/doors
Electric Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ /-57 360 Ou Utilities:OSewer Septic Building Height:
<QVt/NER/LESS�E� ;
Name HName: .SN,trndo;,%, cS Y
Address:-7gaD 6A)/&S0 ,� Y0 Company:`,rp S E)ecfy c of S�Utae"Cn&Xm.
City:__acc( _ 8&J-Dr) State:-EL Address: 1 ZO(o 8e)l Q 11en L.e.
Zip Code: �.334a Y Fax: nj n City: X1314- P i e/)Cz State• FL
Phone No. L'7-70> G-i(o —0830 Zip Code: 3 L49 97— Fax:
E-Mail: Phone No. -7-72 4(-PS•23(03
Fill In fee simple Title Holder on next page(if different E-Mail: I)0cs0ecsr l tti-%e Fat ao/. t.at7,
from the Owner listed above) State or County License: EG /30072 0.3
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTf,ON LIEN LAW INORMATIO;N•
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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.Lucia 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}obsite
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.
Sign ure o Owner/Lessee/Contractor as Agent for Owner S:ATE
na to of ontracto /LI ense Holder
TATE OF FLORIDA S OF FLORIDA
COUNTY OF � r COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thisa day of_ 11 20 _Qby thisi day ofeirgar7 20 `�by
A -ern 6/6/(/
(Namef persoA acknowledging) (Name of p rsoh acknowledging)
)
nature of Notary Public-St to of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Ty of Identificationroduc Type of Identification Produced
�`. \,,le � 's• 1-�;—i.alke.o
Commission No. al) Commission No. NDOLPFI MCDANlEL
arri��o
otP _m '~ : MY COMMISSION r FF91'3Q01
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°�? IVA llV EXPIRES September 07.20/9
Revised 07/15/2014 :v'My Commu611C-Sfate p/Florida '� '�'�"'a""0'O""
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