HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �• l 7• Permit Number: /703• Q z
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RECEIVED
Building Permit Application MAR 10 2Q17
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: To Select from dropbox, click arrow at the end of line
�PROP.OSfD:(MPROVEIVIENT LOCATION• ' -
Address: -ICszlO [`1�i��-Lv�1�=� 7 �a�-1 tom; ���, 3L9
Legal
Legal Description: UQ4 ' ?T 2 k-_412, L-D-:-
Property Tax ID#: qL-0 Doc) 3 Lot No. S
Site Plan Name: _ Block No. v
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCR{PTIONOF WORK
�o Le- L-fo
CONSTRUCTION,INFORMATION.
AdditionalworKtoDeverforme un er t is permit-c ec k all appy:
HVAC Gas TankGas Piping _Shutters a Windows/Doors
Electric 0 Plumbing Sprinklers Fi Generator Roof Roof pitch
Total Sq.Ft of Construction: 5 . Ft.of First Floor:
Cost of Construction:$ 1 q00 ��k Utilities:Sewer Septic Building Height:
OWNER/LESSEE
CONTRACTOR.
Name L ��'� - Name: '10, U C_
Address: L-ICg(Q t-)-)LJ _ _L)L04-e- Company:
LLLInfee
�.�,�cr� State•�L- Address: ) i1S
34952 Fax: City:Goy-- -�l�e--e_ State..-E=
. 7a-3�G- o L(C( Zip Code: 3LI9 8 Fax:
Phone No.���'a�a- y9a�
simple Title Holder on next page(if different E-Mail: Crate al�4-�- rcn 2 Owner listed above) State or County License:construction Is$2500 or more,a RECORDED Notice of Commencement is required.
�S.UPPLEMENTALCONSTRUCTION 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 211 authorize the permit holder to build the subject structure
which is in conflict with any pplicable Home Owners Association ru es,bylaws or and covenants that may restrict or prohibit such
structure.Please consult wit your Home Owners Association and review your deed for any restrictions whic 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 orfecording your Notice of Commencement.
S
Signature of Owner es Contractor as Agent for Owner Signature of Co r License Holder
STATE OF FLORIDA STATE OF FLORI A
COUNTY OF COUNTY OFA e-
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this L_day of J:JQ r Lcn . 20 lZby this of day of HQv--kA .20 3_by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known ��OR Produced Identification Personally Known - OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. d��� mission No. �Cor't 8 y� (Seal)
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GABRIELLEHICKSit r.G 7
?ti EXPIRES:February 2,2021 ; ,ti►�: ;.,,; GABRIELLE HICKS
Revised 07/15/2014 �,� E,�rnN Notary Pubs U"de"mte�s .: Illy commlSSicw#GG 069047
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