HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: .�/.z3 �/, 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. �(
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the',end of line
PROPQSE® LMPR®iEM'ENl" l.®CATIO)V:I
Address: 3317 glCR 1 e Ae de- Fri• ZZ -e- / Ae F( 3 YL E/
Legal Description: t44f aIrle C a.1y Ce �a '��� ��' bi+.f¢ [Q�G ��2,�(� �% O �' �•
Property Tax ID #: 1327-901-0032 " OD O Z? Lot No. .2 �
Site Plan Name: A Block No.
Project Name: T (We..i
Setbacks Front Back: Right Side: Left Side:
d�� �7 �j�4E NlGrc O /d'"aC
]amonal worK lO Oe errormea
HVAC Gas Tank
unser anis permit - cnecK ail
E]Gas Piping
apply:
Shutters
❑ Windows/Doors
Name: o AJ�
Company: C .0,z f14// 4
_
Address: 731? &,1/ eevr 'iOF
_
Address: u`.� .3 r� � �`. v c ti 44~1
Electric
[]'Plumbing
Sprinklers
Generator
Roof
Total Sq. Ft of Construction: //: S. Ft. of First Floor:
Cost of Construction: $ �� .h v Utilities: Sewer oSeptic1 . i Building Height: a 4 � v t
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®1II/NER/SSEE '�C®NTReAI"®R:
m, M NO
ANN=
Name og pin
Name: o AJ�
Company: C .0,z f14// 4
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Address: 731? &,1/ eevr 'iOF
City: A(, �sC/cc State:
Zip Code: ;?�l �5 Fax: Ai(4
Phone No. j5� - yip/ (J
E-Mail:A,, 10
Address: u`.� .3 r� � �`. v c ti 44~1
City: C.--e-le State:
Zip Code: 3Cl 9 Yi Fax: 7%2-
Phone No. 7 72- e/6
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: 70&"
YA4 av, aavh,
State or County License: SCC i_7
l
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: 71A
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 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.whicb 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'p'osted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recordin>? vour Notice of Commencement.
_ Signature of Owner/ Lessee/Agent
STATE OF FLORID —.
COUNTY OF,
The forgoi " . stent was acknowledged before me
this X -L day of 20 aby
s
Signature of Contractor/Licens'e Holder
STATE OF FLORIDA r
COUNTY OF -
The
The forgoing iCl�ent \ �ckt3r 6 Clore me
this day of 20 by
�S��r,�\e1► e— S S LAA -so L G'1
(Name of person acknowledging ) (Name of person acknowledging )
- \-Zk A.&A ,-J i ),-%
(Signature of Notary u ic- State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
Commission.No..Gcco. • 5. (Seal)
Fa rue, FRANCES V. JOHNS
=o ;«•••., �o My COhAMISSION # GG 030038
Revised 07/15/2014 N�9rFOFFvo�`6 •_B°'eOTtuuBudg=tNaarysetvkes
(Signature of NotaryPub]' - tate of Florida )
Personally Known OR Produced Identification
Type of Identification
Produuceedd,
Commission No. L 03. , (Seal)'
. CRY Pu_
* * MY COMMISSION 9 GG 030038
9�\o� EXPIRES: Octo6er29, 2020
FOF FJO -. Bonded Thru Budget Notary Smut_
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