HomeMy WebLinkAboutBuilding Permit Application ICABIJE INFOMUSVT BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number
U Q2
i3t3kfing Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce Ft 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PRE $.Ep�1:1IMP 0 MENT LUCATI6N'�,
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Address: -7 ru
Legal Description: C7
Property Tax ID#: -n Lot No.
Site Plan Name:
Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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DETAILED`DESCRIPTION"
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AdditionaTwofFto be performed uncler this perm check all that apply:
—HVAC —Gas Tank —Gas Piping Y Shutters Windows/Doors
—Electric —Plumbing —Sprinklers Generator Roof Roof pitch
Total Sq.Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: Utilities: —Sewer _Septic Building Height:
OWNERjLESSFE '
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Name Name: -r � (JeJ
Address: C(2,,->) r-T r�A-<r..
Company:0 rJULly t-->Jr\1
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City: 5A I k it, State: Add 241YL C,--)
Zip Code: Fax: city
C'Ce State:
phone,No.fA �0 A R,(n 61 Zip-Cotte: VQ 4"q 'Fax-
E-Mail: Phone No.-C-zll 2 4L/ 2- /;!2 2
Fill in fee simple Title Holder on next page(if different (QA)AtKA Wn &Jt' (.Ct)tA
from the Owner listed above) State or County License:
-if—va—Wit Of tonwo Won I's$ZM or btt,,a RECORD ED'Notitia of L*m Is I%gal mid.
5URPLEMENTAL CONSTRUCTION LIEN LAW INitb MATI�Ny
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 Horne 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,swim g po fences,walls,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWN R:Your failu a to Record a Notice of Commencement may resul n your pa ' g twice for
improvements to �Won-
r property. A Notice of Commencement must be recordedAnd posted o the jobsite
before the first in if you.i tend to obtain fuaarar ing,consult with lera Vran-attorne before
commencing ,or or recordin ur Notice of Commencement.
1
a l S
Signature of Owner sse Contractojr as Agent for Owner Signature of Contractor4Li e s Holder
"STATE OF YLORIO f r STATE Of'FLORIDA '
COUNTY OF c��t —�-`��1 -� -� COUNTY OF _{ _ ��rC!
The fJkng instru e t wa° owledged,`before me The f r oing instru ie t wnowledgefore me
this ay of 20 y this ay of 20 by
V���) Mc�n nA��j� �Pcna-&Ic� (2
(Name of person acknowledging) (Nam of person acknowle ing)
•(Signature•of,Not .Public-State of-Fltuida) (Signatu're.of.Nota blic-State of Florida.) "
Cerso�nallyKnopn_OR Produced Identification rsonally KnowOR Produced Identificationcation Produced
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Commission No <P Ge',. ANGELAelj�l� F ` "11r„iI � (Seal)
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Comm! #FF 234730 ?ti=o`PHY nor,' ANGELA M HUFF
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