HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 'd Permit Number: ��d3�T3 S,4 s-,
RECEIV-':D �=R 24 20V
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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
PR,OPOSE6!MP.:ROVEMEIVT IO.CATION `
Address:. 5 9013- Tt"c 5-49Fa
Legal Description:Un;-I- ncp
Property Tax iD#: 31-109, Lo Q'� �!td G fit,?C� 4" Lot No. ![P�t-1"7
Site Pian Name: Block No. 6220
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED:DESCRIPTION OF,WORK:
CONSTRUCTION INFORMATION
itiona wor to a orme un er this permit-c ec a appy:
HVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
Electric 0 Plumbing FISprinkiers Generator Q Roof Roof pitch
Total Sq.Ft of Construction: S .Ft.of First Floor:
Cost of Construction:$ "7 6LI-0 Utillties:l Sewer OSeptic Building Height:
:OWNERjLESSEE - CC7NTRACTOR `
Name cna 1( Name ar-)<-
Address:,')
-l<-Address:,')&nF< Company:
City:_-cap �r i_State:fit, Address: t�� ?=�.s-L
Zip Code: 3149 iii Fax:-2ff City: Fcx--t �� ccs `�- State:Fe
Phone No.77-q -(50 S-6,5Zip Code:,31%,,9L Fax:
E-Mail: Phone No. "7-10- (95,7 - q 915-T
Fill in fee simple Title Holder 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.
SUPPLEMENT-AL.0 NSTRUCTION i IEN 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 make no representation that is granting a ppe mit 21 authorize the permit holder to build the subject structure
which is in conflict watt any pplicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult w7t�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 yqu intend to obtain financing,consult with lender or an attorney before
commencing work or recordWg your Notice of Commencement.
s
Signature ofOwndr/fv9s'ee/Cb ctor as Agent for Owner Sign ure n actor ce
STATE OF FLORIDA j STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instru ent was acknowledged before me The forgoing instrument was acknowledged before me
this l)3 day of f 20 Lby this Q_�)day of 1\-1 At 20 i 7 by
(Name of person acknowledging) (Name erson acknowledging)
(Signature of Notary Public-State of Florida j (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. 0 L0 (Seal) Commission No.�'��n[o9 D x47. (Seal)
oii��?y"'••.,,- GABRIELLE HICKS ►E1�s ,,, GABRIELLE HICKS
Revised 07/15/2014 a' - MY COMMISSION#GG 069047 .( = MY COMMISSION#GG 09904
=m: •'- "• =�f EXPIRES:February 2,2021
,OF PmnowilluNowymmumewo
,9,`Bonded Th Notary Public Undo tore
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