HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: '\&N Permit Number:
. $I J s RECEI'.' D �,w 241017
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT.LOCATIONs'
Address: q—)b7
Legal Description: I?i _
'Pg1K) P( c-ec�ag-s C'Iub ( Fes L-iq-30) b(.k- (3\ L_D - I � a2 31_70— i lcr3
Property Tax ID#:�1 D c5M n 15"7 DC)CI) '5R- Lot No. l
Site Pian Name: Block No. cl
Project Name:
Setbacks Front Back: Right Side: Left Side:
,DETAILED-DESCRIPTION N OF WORK
15�' 0-� LQ'" y s� Pvc -�r,c� wl (2 L+' C s
CONSTRUCTION INFORMATION:,
Additional worKto be nprtormedun er sperms -c ec a appy:
HVAC Gas Tank ❑Gas Piping _Shutters Q windows/Doors
13 Electric 0 Plumbing Sprinklers [Generator �Roof Roof pitch
Total Sq.Ft of Construction: SQ.Ft.of First Floor:
Cost of Construction:$ 1-16&0 Utilities:USewer ED Septic Building Height:
.OWNER/LESSEE:.: CONTRACTOR:
Name(I-4rg c +lis Name:
Address: Company: Qi,al;4.,
City: �ac�-�. t���c�e State:rL Address: ) C-clf� evgS,
Zip Code:. >gcj&p Fax City: Fbrl• 1?+ rc P Stater
Phone No. ci Sy- 53(p - C97(5 c7Zip Code:_341 q SO Fax:
E-Mail: Phone No.`7-7a-a, - X190-7
Fill In fee simple Title Holder on next page(If different E-Mail:0� ,a t',4
from the Owner listed above) State or County license: JLo gLn cQ
If value of constmcdon is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL:CONSTRUCTION.i»IEN LAW INFORMATION:
DESIGNERANGINEER: 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 Coun mak no represent tion that is granting a permit v�riii auorize the ermit holds to build the subject structure
which is In conflict wait sY pplicab a Home Owners Association rules,bylaws pr an covenants that may restrict or prohibit such
structure.Please consult wit your Home Owners Association and review your deed r 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 pians,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}obsite
before the first inspection.if you intend to obtain financing,consult with lender or an attorney before
commencing work or recordiniz vour Notice of Commencement.
SignatUofner/LLesseeX3—ntr–actor as Agent ror Owner Signatur#of contractor License o r
STATE OF FLORIDA STATE OF FLORID
COUNTY OF Pot-- fit-_L Lute-, COUNTY OV. 54
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thiis-) a day of_MA17-- 20 i2by this & day of 20 17 by
+�-
(Name operson acknowledging) (14arne person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known�OR Produced Identification Personally Known iLOR Produced Identification
Type of identification Produced Type of Identification Produced
Commission No. 0::, LX,2Oq 7 (Seal) Commission No. t7b, b4pgo Y7 (Seal)
Revised 07/15/2014 ' � ;_ My COMMISSION#GG:2M02
47 _*: :*_ My COMMISSION#GG 069447
pp �o`* EXPIRES:February 2, "s� ;Q; EXPIRES:Febttkty Z,2021
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