HomeMy WebLinkAboutBuilding Permit ApplictionALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
..F .L 0. R 1.,.,Ll j%
Permit Number:
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 X
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line I�
PROPOSED IMPROVEMENT LOCATION: _
1
Address: 9 Q,Q) C PC"��l �.,�� 1,30
Legal Description: rve ourva rx-eC—OO�A (_' nnC_1C7_ �
Property Tax ID #: r) j� -� _ cr Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION: l
Additional work to be i3erformed under this permit - check all apply: 1
HVAC 0 Gas Tank Gas Piping Shutters Windows
/Doors
0 Electric Plumbing Sprinklers 1:1 Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities:Sewer LJ Septic Building Height:
OWNER/LESSEE: I J CONTRACTOR:
NamesY 1Name: l✓ it C-, i ,
Address: �E) cy--,K IC LA V-,, Com anyY_ AC7e` 1r P 1 �I,CY-11 j ►''l C'
City: 'C ,fir State: CJ_ Address:
Zip Code: ONO ( ED Fax: City: c�1 ���.� - State: -R -
Phone No. Zip Code: �j�1 C) Fax:
E -Mail: Phone No.
Fill in fee simple Title Holder on next page ( if different E -Mail: 041 'r2a"
from the Owner listed above) State or County License: C.C—L ILL
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:
Name:
Name:
Address:
Address:
City:
State: City:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable BONDING COMPANY:
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.
Not Applicable
State:
Not Applicable
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 your Notice of Commencement.
Signature a/CoI?!� as Agent for Owner
STATE OF FLO
COUNTY OF (:I{
The f rgoing Inst ent wa's acknowledged before me
this day of YT f ( � . 20 jaby
1 ry rn. r_Cyv_ : 1.p T -Y-1 If )"--yttA
(Name of person acknowledging)
Ick
Signature of Contractor/Lice a Ho3 er
STATE OF FLOR
COUNTY OF �kr-� A
The forgoing instrument w s acknowledged before me
this -5 day of N_�N 1� , 20 11 by
(Name of person acknowledging )
(Signature of N to Public- Sta lorida) {Signatur of6otyPubh Sta of Florida )
Personally KnownOR Produced Identification Personally Known OR Produced Identification
Type e of IdentificatXnProduced Type of Identification Produced
Commission No. ) Commi,sinn Nin (Sem
�LI,Y KIRBY
My COMMISSION #FF109962 =_°' KELLY KIRBY
". ` i, N71 vivm�aawry err ua�
'•.��F�;�:.� EXPIRES April 6, 2018 �;`•,
'' .. EXPIRES April 6, 2018
Revised 071151201L (407)398 -0153 FloridallotaryService.com P�`'••~ p
(407) 398-0153 Floridallo"Service.com
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DATE
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