HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �-�C-/ -/ Permit Number:
•
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 452-1553 Fax: (772) 462-1578 Commercial Residential
NEKMI I APPLKC A I iUN FUR: To Select from dropbox, click arrow at the end of line
PROFUSED IMPROVEMEN I LUCAI ION:
Address: 117 Xz, JD/,� 2 h -e -- -
Legal Description:
Property Tax ID #: 1 �T -elilli V G ZY a Lot No.
Sate Plan Name:
Project Name
Setbacks Front Back: Right Side:
UE I AILED DESCKIP I IUN OF WURK:
Left Side:
CONSTRUCTION INFORMATION:
-at4-RlFin,nai-worTc to -6e --pe for—mei u— n�e�
HVAC Gas Tank
Electric Q Plumbing
Tota Sq. Ft of Construction:
Cost of Construction: $� 3 a
OWNER/LESSEE:
Block No.
tTiis permit = c e-ck a1T app Y:
Shutters Windows/Doors
❑Gas Piping
OSprinklers Generator Roof Roof pitch
i�►�i'�iliBi , :gym
Sq. Ft. of First Floor:
Utilities: []Sewer Septic
Address: of ,Sf D eln'11!r,4V-V
City: F 2 z St I-11 c l s State: F�
Zip Code: �yl��o2- Fax:
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Building Height:
Name:
Ci,'(c,TIS 0A 6ky\CIgI
Company:
L u 37o m A, c S t S eVkl ; tic,
Address:
16' 15 6 E \/! l I as !areen �� r
City: ro 2T 9t. L uci c- State:rZ-
Zip Code:
a +q5o - Fax: 711,2- J 3 X5-1 9 d
Phone No.
1 33S - 323 1
E -Mal:
Cu Stcir Sys Cc c-( CGvrt_
State or County License: 5 18 t
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMEN I AL CONS I RUC I ION LIEN LAW INFURMAIION:
Name
Addre
City: _
Zip: _
NGINEER: — Not Applicab
Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
ri+"d
Zip: Phone: _
State:
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zi p: Phone:
Not Applicable
tate:
Not Applicable
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Countyy_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 Y rppr Mbit 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 exemptfrom 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 /^I
Signature of Owner
as Agent for Owner 1 Signature of
STATE OF FLORIDA S� U C; e
COUNTY OF
The forgoing instrument was acknowledged before me
this I o day of A AR I i._ 20 I _bv
- C.urb. �14frtmc�ns'
(Name of person acknowledging } /
(Signature of Notary Public- State of F! rKda }
Personally Known ✓ OR Produced Identification
Holder
STATE OF FLORIDA
COUNTY OF SY L U
The forgoing instrument was acknowledged before me
this 10 day of R OP -1- 20 1 7 by
rzr15 3tjmt� On S
(Name of person acknowledging)
(Signature of Notary Public- State"of Florid/
Personally Known � OR Produced Identification
Type of ldentrfuation ProdCuced ' / !cam Type of IdentificationProduced
Commission No. ✓ `�� BEI QMmission No. C4 bl O rJ �sy t'
myCjOMVASSION# 31305M
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