HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICAB. EE I FQ MUST BE COMPLETED_ FOR APPLICATION TO BE ACCEPTED
Date: O Permit Number: I r? o,� — (nicks
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 I
I PROPOSED -IMPROVEMENT LOCATION: _ . I
Address:
Legal
Property Tax ID #: / iv(5
Lot No.
Site Plan Name: Block No.
Project Name. /ZQ.Q4",Pr. y_na. )
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: kU614 0 -
CONSTRUCTION
CONSTRUCTION INFORMATION:
Additional wor < to be nertormed under this permit - c ec c a appy:
1 VAC L_ J Gas Tank Gas Piping_ Shutters Windows/Doors
NA
Lnj Electric 0 Plumbing Sprinklers El Generator F]Roof Roof pitch
Total Sq. Ft of Constructio��n:�� S Ft. of First Floor:
Cost of Construction: $ `14 �o� Jam. L� Utilities. Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name:
Address: D )-
Company:
City: State:.,
Address: eYJ—
°
Zip Code: 3 !iy qy — Fax:
City: 1 �.L.t��
State:-I"L-•
Phone No. 10 l-- 6- 04- 937-7
Zip Code: 2,09q,5
Fax: 4L/ - y%7 8
E -Mail:
Phone No. ,&I, !ley
-7
Fill in fee simple Title Holder on next page ( if different
E -Mail: IbIz9& &;dk
-A 64AI" � .
from the Owner listed above)
State or County License:
o� 4,
3 •-
"4 /--;a-
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: ps
Address:
Address: T
City: State:
City: State:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name: ill
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 yciyoifftend to obtain financing, consult with lender or aney before
commencing work or_cecaEdinKvour1lNotice of Commencement. / )
er/Lessee/CoWactor as Agent for Owner I Sign
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF D/`Z COUNTY OF a
The forgoing instr pent was acknowledged before me
this __y day of 20 aby
of person ac4yow!Adging
(Signature of Notary Public- State of Florida
DAVID RAYMOND PRUE
Personally Know pCOTOY0%Rtification
Type of Identific d WATE OF FLORIDA
Comm# FF192675
Commission No. CE ° Expires 1/2"P
Revised 07/15/2014
The forgoing instrument was_ acknowledged before me
this _ day of tnn . 2 C_t/ 20 _LZ by
e.1
(Name of person a
(Signature of Notary Public- State of Florida )
DAVID RAYMOND PRUE
Personally KlNe.'eE
�qW (kdentification
Type of IdenP dLOF Rl.ORIGIA
Comm# FF192675
Commissionui►° Eat t.ee 1/26/201bSeal)
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