HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ;L1111 Permit Number:
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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 Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 171 5 A.
Legal Description: Ue— Adt1&0A ate I CAT
Property Tax ID#: 3y I 9 'S4 0` 0100 (0005 Lot No.
Site Plan Name: ol- Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION: {
Additional work toa nerformed under this permit—c ec a a appy:
❑HVAC Gas Tank Gas Piping Shutters Windows Doors
Electric ❑ Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: / Sq. Ft. of First Floor:
Cost of Construction:$ �7 570 ' Utilities:11 Sewer 11 Septic Building Height:
OWN ER/LESSEE: CONTRACTOR:
Name 7W /✓ L Name:
Address: 370K W SIS n Ayf- 51k k 2D 10 Company:
City: WK State:L Address: r
Zip Code: ,,la0 9 Fax: City: V. % �1 State:
Phone No. C7 � Zip Code: cam- Fax (4
E-Mail: -Ga WA, Phone No.
Fill in fee simple Title Hold r on next page(if different E-Mail:
from the Owner listed above) State or County License:
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: _X Not Applicable
Name:'5CKe_V to Name:
Address: 2.'SS Afh&," -W SLU4-u 30ffrE Address:
City: State: City: State:
zip:3 q3� l Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDEN Not Applicable BONDING COMPANY: XNot Applicable
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Name: -5w 0 t� 6_ 1 PA. Gly"- LLC_ Name:
Address: 37oY W. 5uua�h Am '5�d4_ 2-06 Address:
City: L City:
O
Zip:_ _36Phone: -VS- V 1700 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 o tice of Comme -e�ent.
Ma--'CL o -e�of ��
s
Signature of Owner/Lessee o ra r as Agent for Owner Signature of Co tr toy/License Holder,
STATE OF FLORID STATE OF FLORIDACOUNTY OF A' SCJ-O\r 0 L COUNTY OF'Z*
*
The forgoing instrument was acknowledged before me The for oing instrument wa�s-acknowledged before me
this �V1 day of' �(C.� 20 11by this day of �� 1 20 by
f�® 1M 11n CAVI 5ICA6aq_�— ` L
(Narnt of person acknowledging) (Name of person acknowledging)
(Signature&Aotary Public-State of Florida) (Signature of Notary Public-State of Florida
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Personally Known OR Produced Identification Personally Known tiOR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. "Y'P�'•.,
A� l� Y H. G,UVTO ommission No ``'�Y„�� I.tEA=HER HARDEN .
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' MY COMMISSION#FF11119 �`` ”"'
�.� `�'= Commission#GG 25312
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Revised 07/15/2014 (407)398-0153 Floridallotaryservice.corn "%.?��,,.o'�;`' August 28, 202
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