HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I $1 I? Permit Number11 IRWIN III _1
. 1
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®P®SED IM'PROUEME�NT LOCATION:
Address:G�c'af 9z -cd'
Property Tax ID #: 13o 1 6 b Z DD AU no 3 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
lq- 79 i A S 6�,q c -Q) r /V 7- * G--- `( z 1_:_� A)--14 .
HVAC
11 Electric
Plumbing
Sprinklers
LJ Shutters
Generator
El-Windows/Doors
E] Roof Roof pitch
Total Sq. Ft of Construction: _ SFt. of First Floor:
Cost of Construction: $ !' �d Utilities:ln Sewer Septic Building Height:
®WN I ER/LEzBaRE;I
C�ONTRACm�:1
Name F'J+Jt� CE 141 -fi r1 a+1 c r 4i Cd re
11
Name: ,1- PJ L✓%iG?� vyC,OZ
�f
Company: 69),t)azy F 7eg,7,LS C L C
Address:_ I V I S,s Ik,w;brl 1., > -e_
City: State: F(
Address: tic�-- ST�vS Z�c,
Zip Code: 3`1 q S 3 Fax:
City:X1/01— S zc,�� State: GL
Phone No.
Zip Code: 53S/ 8 37 Fax:
Phone No. 7 7 2- Z Z c -f R I ( C:?
E -Mail: 642 RL 47 C172 y i Si Y_ �/
E -Mail: Wi LL i,c-m se I ISJWQ Gm &;J d t
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License: eF',�f_ /9 2 g Z G sB
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTgL CONS RUCTfON LIEN LAW IN'FORMATI®N:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 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'of
ergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, sen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a NoCommencement may result in your paying twice for
improvements to your property. A Notice of Com menement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain finan 'ng, consult with lender or an attorney before
commencing work or recording your Notice of Commence ent.
0
s
ature
ractor as Agent for Owner
ature of Contractor/License Ho
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF I_KC_ � �_ _ COUNTY OF
The forgoing instru ent as acknowledges before me
this 4�ay of i 20 1 y
,Name of person acknowledging)
The f rgnjng instru nt was ackn wledge before me
this day of 20y
(Name of person acknowledgi
0�^
(Signature of No -a y,,Public- State of Florida )
�. _Y y ��-aiaemn naa
no„wry •SS��� �� ent ication Personally Knoyintn��; OR Pro NG ., enti ication
T e of Identifrca ri P oduc d fC
trficatipn PCO u & YP
m lis - Si F
AA0
. ' ,"•�:qL National Notary,qssn r,.,r� mission
No. �A;t:S.eal: Commission No. tom. # ��Worida
'' 1 "• CXPire 4730
through Nation_,,May 27 2
"`'`'•��YAss�,
Revised 07/15/2014
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