HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �t7
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) 462-1578 Commercial
Address: l U-3 I D S d SAA) 4_j�, 4e-5- /p q fS66 S �i' _ t4
Legal Description: 0CiA)RtSC 60A)Jo (IPr lucl
ential
Property Tax ID #: 41 TI I � t'C)0,1 C7o I Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
IDETAILED DESCRIPTION OF WORK:
Block No.
` Ql,Cc _A , �v S'�� a ��/i I/L sols m w/ 6" K w 144,4
CONSTRUCTION INFORMATION:
Adq1tiogal work to be erformed under this permit- c ec a appy:
HVAC Gas Tank []Gas Piping _ Shutters Q Windows/Doors
Electric 0 Plumbing 0 Sprinklers Generator g Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ �S6 UO Utilities:qnSewer 0Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name—A6 VQ b6win
Name: iCliA VL.1
Company: U!>L9 V'&fiLjE(
A/c 1A) C'
Address: ?. 0, JA 1
City: i' L>L6EnJ State:.MCAddress:
C33 N S /No/z
12vN z.J
Zip Code: W Fax:
City: S -
State -f --(-
Phone No. J,0'1 9q'4 a,9yla
Zip Code: 3J 9
Fax:
E -Mail:
Phone No. SQr)a &iik,
Irl '5-`'r
Fill in fee simple Title Holder on next page ( if different
E -Mail: R VoL.k040.T
Qv I,1 @ a, (ti n 14 . coM
from the Owner listed above)
State or County License:
Ps I A 5 -
If
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION 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 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 recording vour Notice of Commencement.
as Agent for Owner
STATE OF FLORID AL� _ LA�,E!_ r
COUNTY OF '`T
The forgoing instr m nt was a c pwledge efore me
thisay of 20 y
(Name of person acknowledging
Sil'Wa-ture"ofConfr�dor/License Holder
el,?,(( RAM
STATE OF FLORIDA
COUNTY OF S+- Lc, _(, `e
The forgoing instrument was acknowledge before me
JD
this iay of t � enl CJ� , 20 by
(Name of person
(Signature of Notary P lic- State of Florida) (Signature of Notah(i Public- State of Florida)
Personally Known O odu dentif ati n Personally Known Produced Identificatio
Type of IdentificatiQ Type of Identification Produ UL)
ELA M HUFF
Commission No. ?=4.aY PUa`c'= Notary Publigs�e of Florida Commission o. '
ommission # F 234730 =o�nRY Pia(ANGELA M HUFF
t`•' My Comm. Expires May 27, 2019 Notary Public -State of Florida
Bonded throng ational Notary Assn. .., n .. _Lummission # FF 234730
- M
Revised 07/15/2014 comm. Expires May 27, 20i = ti
J
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