HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 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 Y
PERMIT APPLICATION FOR: Window/door
Address: 4LIO 4'11"5E1 'gt_y b `Fo¢T P W -/—E -FL �4q
Legal Description:IwDstkw tuLYL ��i �r i 5 l oT 5
Property Tax ID #: 31+0Z6006
Site Plan Name:
Project Name: �I i;J T -t'
Setbacks Front Back:
9- � PL.A GIr z V'00 ,2-,5
0106 000 -z-
Right
Right Side: Left Side:
'AFAG7- Si mit -Foa- c i
Lot No.
Block No.
Haamonai worK to De ertormea unser tnis permit - cnecK an fj apply: :I
OHVAC _ Gas Tank ❑Gas PipingMGenerator
Shutters � x Windows/Doors
11 Electric E]PlumbingSprinklers El Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
t
Cost of Construction: $ 4,500 Utilities: _ Sewer - Septic Building Height: `� • i
UWNEftjLESSEE
CONTRACTCIR
kt
Name Tido „1i4 S EN> 'f'1
Address: 400 4LU7
Name: WA%4S T
Company: FiA is
Address: 3oUL1 5w1
City: foams
Zip Code: '�Wi 067—
Phone No. 064 "Y i,Z
E -Mail: �I bz o���� c7Fi�4
State or County Licensee ,ICS
►2n+t--+i
City: P=-Cw r vivP-GE State: -L
Zip Code: '%'Ia ':�Z- Fax:
PhoneNo. 11 S 4 &c1%36O$°I
4-L_wb 3'r
State: I- L_
Fax:
1-4L1 15
E -Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
tA- i�2o�uGTS_ ccv`n
&ci I %qo
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
I
SUPPLEMENTAL CONSTRUCT{ N L#EN LAW INFC}RMATION,.
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: I State:
Zip: Phone:
Zip: Phone:
I
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: =Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone!.
REVIEW
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OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do theiwork
and installation as indicated.
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 1 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, oar
an attorney before
commgDpMwork or recording our Notice of Commencement.
Sig ture C t /License Holder
Signatu of Owner/ Agent/ essee
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF 0Lyaw-
COUNTY OF lyov.warAV
The forgoing instrument w acknowled ed before me
e
The forgoing instrument was acknowledged before me
this ti- day of 210E by
this 3l day of_ , 20Efby
-r"W a5 Ax"' ►�t`C%
t. —"C 00 m 311(&.4E
(Name of person acknowledging)
�y
(Name of person acknowledging )
4
I
(Signature of Notary Public- State of Florida }
(Signature �NotaryPublic-Sta, t of Florida )
1
Per on4ljg,�epwn OR Produced I en fication
Personally Known V -.-'OR Produced Identification
Typ p#'�d�nt`}tat���cFe� BIRKIN
Type of Identification Produced
" MY COMMISSION #FF033205
Q
Co rritis�ridd. EXPIRES July 2. 2017(Seal
Commission No. (Seal)
(407) 398.0153 FloridallotaryService.com
i dAN��@ 4 LU 9
1r 7a C MMIZ101
Revised 07/15/2014 Z MYEXpIR68 AU9ust07,
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