HomeMy WebLinkAboutpermit applicationALLAPPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development5ervices
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
PROPOSED IMPROVEMENT LOCATION:
Address: SO C—
Legal Description: " c- �35a-- k°f3- of" A a.l�c
LOC _"rt`.i - \" tko l�
Property Tax ID #: as - 11,06 �s - 00-11 - O 00 - Lot No.
Site Plan Name: \� Block No.
Project Name: VC -.)O
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Y_v3 " -14— o
0 Plumbing
❑ Windows/Doors
❑ Roof
Total Sq. Ft of Construction: c t SFt. of First Floor:
Cost of Construction: $ S� S 1 Utilities:cnSewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name r1
Name: G4\C,escAn
Address: \o S
Company: < 61,a
City:�+Gv11M�51 Statel_'�i
Zip Code: f0�1� � - Fax:��
Phone No. CO a Lv - caa- k - lk 9c)
Addressp-:SL1�a6
City: pC\V1,lSL State:-
Si1'3^ O`er
Zip Code: Fax:Ct FS
Phone No. C S4 l '_7 l
E-Maih
Fill in fee simple Title Holder on next page ( if different
from the owner listed above)
E -Mail: R," 136 C -'c_ . czrv-
State or County License: Cc," C^ D'S$1 I–E
It value of construction is $2500 or more, a RECORDED Notice of Commencement Is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not ApplicableMORTGAGE
Name:
COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ 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 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 insg ion. If you intend to obtain financing, consult with lender or an attorney before
as
STATE OF FLOBWA STATE OF FLORIDA
COUNTY OF hS�'.Jar� COUNTY OF
The forgoing instr�urient was acknowledged before me The forgoing instrument was acknowledged before me
this . day of Juc n_ 20 �by this 11 day of 73� 20 U by
(Name of person acknowledging) (Name of person acknowledging) 13
' n' 6_ V GC/V C -
(Signature of Notary Public- State TWlorida )
r
Personally Known � OR Produced Identification
Type of Identification Produced
Commission
`4�'ci4'P"'"
(Signature of Notary Public- Sta of Florida )
Personally Known_ OR Produced Identification
Type of Identification Produced
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Revised 07/15/2014 EXFIf1CSFehruay2.201 L-;,
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