HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST:BE:COMPLETED FOR APPLICATION TO BE ACCEPTED, ^^AA 11
Date: l IQ�Zo I� Permit Number: :`1014• �
FORM
Building Permit Application
Planning and Development Services
Building and Code.Regulation Division
2300.Virginia Avenue,:Fort Pierce FL 34982: Y
Phone::(772)462-:1553 Fax:(.772)4624578 commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox,:click arrow at the end of line
PRQP.OSED'IMPROVEM0
_ENT CATION
Address:
Co(o S A e 1 r s F4-. e;� , FL 3q9�)
Legal Description: I P� ��Y'VW C �--o 1--ul
�o�2 3-7 3 z a9
Property Tax ID#: 130` — 50V-00-73 —000-9 Lot No. J
Site Plan Name: l--LA-v-) <4En� Block No.
Project Name: V C-)
Setbacks Front Back: Right Side: Left Side:
DETAILED'DESCRIPTION OF WORK
7 n 50.1 o,�� o
CNSTRUCTIOWIN_FORMATION
itiona wor to e e orme under this:permit—check a appy:
HVAC Gas Tank Gas Piping Shutters a Windows/Doors
Electric 0 Plumbing Sprinklers []Generator Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ 3 -�9 Utilities: Sewer Septic Building Height:
OWNER/LESSEE: , ',.,' c,CONTRACTOR
Name V.V-, Name:- lr �QII.y1 -T—
Name
71
Address: !'v 5 )he 1 i Company: �•� 1 �rr a e�a-,� S�t� e✓�,
City: State: FL- Address: X100
Zip Code: 3`-1°15 I — Fax: ' City: e,t-c_>r State: f Z—
Phone No. `739 - (1-71-1— (9862- Zip Code: Fax: -772_--79L1— IS-90
E-Mail: Phone No. `7-7 Z— ",-7,?y— 15 g)
Fill in fee simple Title Holder on next page(-if different E-Mail: a V s�ln1^ri c�tviG�S�u��z r ih G� `� ►�'uA
from the Owner listed above) State or County License: 02 y 3 9
If value of.construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION.-
DESIGN ER/ENGI NEER:
NFORMATION: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 makes no representation that is granting a permit will authorize thepermit 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[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 our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of ontractor Li nse Holder
STATE OF FLORID STATE OF FLORID _
COUNTY OF��"C` ' COUNTY OF �Q .
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this Q day o4Q JQ 201D—by this j]_day of 20 by
1
(Name of person acknowledging) (Name of person acknowledging)
JSiatupkeofotary Public-State f Florida) ( ignature of Notary Public-Stiate of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification'Produced
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/201 ,o<Pa�P6al,•• LA]AHNA INGRAM
LASHAHNA INGRAM ;� , Notary Ptate of i'tOrldaotary Pu Ifc- a e MComms DecREVIEWS FRO . NtwiGomm. x�res X7 91PLANS VEGET' i �A 1U3 4F
R� Atd�bVCOU ' ;-IEWOmmis ionW Ass . FEVIEW REVI "° RPME�11b'ron r n.
DATE4
COMPLETE
INITIALS