HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST:BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: b ?. Permit Number: 1 (rn 3
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
PROPOSED IMPROVEMENT LOCATION: j
Address: ) S o v, v -i -n r tom: " f\ v -c_ _i 5- m i �✓
Legal Description: n: '� �'' ��(7 S l� low' �� ("06 Lo �
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Property Tax ID #: ( Z
Site Plan Name:
Project Name:
Setbacks Front Back
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Right Side: Left Side:
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of line
DETAILED DESCRIPTION OF -WORK:
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c-c0�v_k T 12s .
Lot No. 9 b -,—
Block No.
CONSTRUCTION INFORMATION:
itiona wor to e ne orme under this permit- check a app y:
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HVAC Gas Tank ❑Gas Piping _ Shutters ❑ Windows/Doors
❑ Electric 0 Plumbing Sprinklers ❑ Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First. Floor:
Cost of Construction: $ 09 z Utilities Sewer ❑Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
i
Name ri G OZ /VD
Name: -
Company: N; cl r' lam( wV1Ty�
Address: .;1 PO A/ K� n�'L
Address: �� ) S (A !tel )� 2 I' " Ci i''-
City: it ck- State: L_
Zip Code: 9 S I Fax:
City: 1 ` f l 2. rd State:J___L.-
Phone No. "71 `1-L = Z � 2 3
Zip Code: -3q,15- I I Fax: 7-n-7 `7cl - l Sv
E -Mail:
Phone No. - /5-9 /
Fill in fee simple Title Holder on next page ( if different
E -Mail: -icfi '-bkn' V'
from the Owner listed above)
State or County License: �� �� � % �f t'a 0-7
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required
10
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
City: State:
Zip: Phone:
Address:
City: State:
Zip: Phone:
I
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
Zip: Phone:
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 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 ianother 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
commencine work or recordine vour Notice of Commencement.
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Signature 4f Owner/Lessee/Contractor as Agent for Owner
r
STATE OF FLORIDA
COUNTY OF 511�L ��
The f ing instru nt as a knowledgedefore me
thisday of 20/ by
i V --A Q
of person,
Public- State of Florida )
Personal
^`1.) •= Commission # FF 234730
Corn mis, o,n_Expires May 27, lrM19
Is
Bonded through National Notary Assn.
Revised 07/15/2014
Signature df Contractor/License Holder
STATE OF FLORIDA LLA COUNTY OF
The forgoing ins ument was acknowledged�re me
thiso�` ay of ✓; 20� y
(Name of person acknowledging
(Signature of01tary Public -'State of Florida )
Personally Known_ OR Produced Identification
Type of Identification' fodv
GELA M 4UF!
Notary Public - State r
Commission No. - (Seal) rn
sion # FF
My Comm. Expires Ma
a conal
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