HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLET►
`INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEP
Date: 5 aro\ Permit Number! V14 5"
-.
RECEIVED MAY 2011
Building Perrhit 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 F
PROPOSED IMPROVEMENT LOCATION:
Address: -CIO�_AZ, 4&Qe
Legal Description: L,1 �
Property Tax ID#: Lot No.,A-P
Site Plan Name: Block No.
Project Name:
A
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION: '
Acid itional work to be nerformed under this permit—c ec all appy:
HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ .30y� Od Utilities.Sewer Septic Building Height:
OWN ER/LESSEE: CONTRACTOR:
Name !13 Name: `►','41�r�S ��//JG 1�
Address• �' SGzJ '�� I Company:,ALL�i(�4 fLej G
City: State:/4?, Address: /,?5/J
Zip Code: �`'` "� Fax: City: &I Y rr. zye 11= State:'
Phone No. Zip Code: iw_=3 Fax:
E-Mail: Phone No. _7_70- �✓������
Fill in fee simple Title Holder on next page(if different E-Mai(:
from the Owner listed above) State or County License:i /3L�h S U
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SU,PP.LEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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 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 recolding your Notice of Commencement. 1-01
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zlgeolek�2;_�, ��/,_e4 s
Sign-ay-'e of Owner/Lessee/Contract r s Agent for Owner Signat a of Contractor License Holde
STATE OF FLORIDA STATE OF FLONDA ,
COUNTY OF -5V. LUQ t COUNTY OF S k �
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this°-S day of V#sdV� 20 n by this 15 day of VN" .20 by
(Name of person acknowledging) I (Name of person acknowledging)
(Signature of Nota - ___ (Signature of Notary Pu ic-State of Florida)
o�P'rr'v,'u ,; DEANNAMARIEGIVENS
Personally Known ''' rdd(&VVdEh`NFiE ? 923 Personally Known '��P�qR P� � � I " on
Type of Identificatio P � member 1G,2u2 Type of Identificati r used twFcbM
EXPIRES:December 1G,2020
one ru
ondedThruNot-
Commission No. �+' ` a ndenvriter
Commission No. Seal )'
Revised 07/15/2014
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