HomeMy WebLinkAboutBUILDING PERMIT APPLICATION5WDm%ttck\5 t 5'HV-c.GCLO• of%
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning old Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Port Pierce FL 34.982
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
Legal
Property Tax[D#: /4LS' (u f1J' f/UYry-OG
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
7�HVAC L IGas Tank UGas
11 Electric ❑Plumbing ❑Spr
Total Sq. Ft of Construction:
cnst of Construction:5 337b
- y Lot No.
Block No.
Left Side: /'/2.1
25.4 s�4UE
1a �� Sy5(em I'7 Sc�iE'
pipingc ^o _Shutters ❑Windows/Doors
riders ❑ Generator ❑ Roof Roof pitch
Sq�.Ft. of First Floor.
utilities:Sewer ❑septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
Company: CUCtr)/ COoiinq
Address: 32.1a S Lgke g,2t.j C,P- 7-ZO&
Address: ICO BOX 7-1179/
City: �/�Iac Z _ State:IffL
Zip Code: 3Y9y9 Fax:
Phone No. Z'lf LSU 6'LZ17
City: Pe C4 S{- Luce IN- State: FL
Zip Code: 3gqff3 Fax: 333 39lw
Phone No. 95� 7S 3V
E-Maik G Bis
C/'ll ca VcLlfy. Colnthe
' E -Mail: �-
[Fillfee simple Title Holder on next page(if different
owner listed above)
'Y0
State or County License: CAC- (8) 7(.0
If value of construction ls$zbuu or more, a xcwnvcw Nut — — —-,----
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: NOt Applicable
MORTGAGE COMPANY: 10 Not Applicable
Name:
Name:
Address:
Address:
City: State:_
City: State:_
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: 11 Not Applicable
BONDING COMPANY: Not Applicable
Name; 7
Name:
Address:
Address:
City:
City:
Zip: Phone:
I
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
is in with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
which contlict
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 Comm cement.
/J
..y' �HSY' s
' ature of Owner/Less a/Contractor as Agent for Owner 5' ture or Contractor License Holder
STATE OF FLORIDA STATE OF FLORIDA ST. LU.GIt
5T• LUGte COUNTY OF
COUNTY OF
The s�oor��gqin9 instrument was acknowledged before me The f__or__&&p.ing instrume t was acknowledged before me
�% MCA 2011 by
this Way of MCt 20 LTby this— ayof
Joshua $ LACK J6Shvok �Dv C k --
(Name of perso acknowledgi ) (Na son a wledgin )
1\f //� (Signat3 re of Nota blit -St a of Florida) Inlpl
(Sign lure of o ary Pub/lit State of Florid `wP,�LVN S�Ryh / pSv"tl�(N Sq p
�$�rspnally ✓ ��i
Personally Known `" OR Produced int Iw'' Known OR Produced I`t•••.
Type of Identification Produced C �g.'•t to of Identification Produced
Commission No. (*03934 •fanmission No. D35;348't(5ea
ubnc unee; •k�, \C T9p'iPpba Und. •' \�
���iip
Revised 07/15/2014 &/c, stA��pO� i2 e....... E�F���
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