HomeMy WebLinkAboutBuilding Permit Application //ABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
e: C0' 7— ZDn Permit Number:
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■ 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 i Residential
PERMIT APPLICATION FOR:
RROP, QSEJ® INPR01/E(�/INLOCATIaN:
Address: P'OrcG FL 3ytiLS
Legal Description:
21
Property Tax ID#: &3x��G� —� ( QM Q�Q� Lot No.
Site Plan Name: Block No.
Project Name:
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Setbacks FrontBack: Right Side: . Left Side:
DETWAILED QESCRIPTI®N OF WORK:
CaNSiTRt1CTl•ON 1'NFORMATI;ON:
---------
Additional work to be performed under this permit—check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters —Windows/Doors
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Electric _Plumbing _Sprinklers _Generator Roof Pitch
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Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ ")OtJ Utilities: —Sewer _Septic Building Height:
®UVN4ER/LESSEE: - CC?NTRA�GT®R:
q
Name-;4 L WUc.M1-e TC Name: QUO bU Hol?1 .Ns
Address:g51 ErHe,a!d Ave Company: De.P.Aw-+61'v 5Fuc" d- Ani w11 I
city:F4-'. pl2«c State:�L Address: 6oSS N U5:�- + .-1
Zip Code: 34(4yS Fax: City: mak, P,erLe,• State: FL
Phone No. 772- 263-386 Zip Code: Fax:
E-Mai1:T)av%c�WCL. 141 eW4,/. CO en Phone No 7-12= y65- LA2LAZ_
Fill in fee simple Title Holder on next page(if different E-Mail �G�►r}oloSi'ucco 401 .Com►+-�
1 from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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IIENTA�X CO'NSRIJCTf®N LIrEN �AUU INFORIUTAT
SIGNER/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:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permifto do the work 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 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 recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signa ure of Contractor/License Holder
STATE OF FLORID STATE OF FLORIDA
COUNTY I COUNTY OF A
Thergoing inst ument was acknowledged before me The f going instru ent was acknowledged before me
this day of 20�by this day of 2611- by
(Name of person acknowledging) (Nam f person acknowledging)
ig ature of Notary Publi&State of Florida) 'gnature of Notary Public- to of Florida) \
Personally Known OR Produced Identification\ Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission No. ,:,(Seal Co mission No%� ===
- �, , SHAHNA I
y n&a,,, LASHAHNA IN611AM e o�PR�"bay,; Notary Public-State W Florida
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DATE
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