HomeMy WebLinkAboutBuilding Permit Application II
All APPLICABLE I � O MU T'BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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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
PER MITA PPLICATION FOR: !
Address: T\- 5 .
Legal Description: �S�� t=. �LAx� �1 Wl -��hGt�z �, L✓y- 5 1 C�-�c�
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Property Tax ID#: 3 3.a 1 U � 1 D C>v �( j i, Lot No.
Site Plan Name: Block No.
Project Name: t.?L LQ (�-r�rG`Ce _ Df�>I>J2
Setbacks Front Back: Right Side: Left Side: I;
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Additionalwork to be pertormed under this permit-check all that app yt P
—Mechanical —Gas Tank _Gas Piping —Shutters i° _Windows/Doors
_Electric —Plumbing —Sprinklers —Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ /(9o0 Utilities: Sewer Septic Building Height:
OWN :
Name ��o�k �� A h Name:
Address: V�c ZCCompany: tnv5 6-nnsv 1Dvo-f S
City: k- S� .� .tx I State: f- Address: 5) -4 S �I�(�r-iD, c Au
Zip Code: 3461 S7 4- Fax: City: TV �
S-F.1-vim!Ll_ State.•
Phone No. 9 ILA - 3 t,- Zip Code: 3�9 S� ; '� Fax:
E-Mail: Phone No
-SSS
Fill in fee simple Title Holder on next page(if different E-Mail (' b�unnf1�u vio►-s,4� �w���LS�. d�from the Owner listed above) State or County Licensee
If value of construction is 2500 or more,a RECORDED Notice of Commencement;is required.'
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: -Not Applicable
Name: Name:
Address: Address.:
City: State: City: State`.
Zip: Phone Zip: Phone:
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FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPAN . Not Applicable
Name: X Name:
Address: / Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR IDVIT:Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or ins, lation 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/Agent/Lessee/Contractor Signature of Contractor/License Holder
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STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF _c f�C�`� COUNTY OF
The forgoing instrum nt was knowledge before me The fo oing instru ent was knowledg fore me
thi�_day of 20�by this day of 20 by
C-e \0 C-ozIQ
(Name of person ackn ledging) (Name of person acknowledging)
'U
S' attire-of-ll'0
ry Public-State of Florida ) (Signature of N ry Public-State'of Florida)
Personally Known OR Produced Identification Personally Know OR Produced Identification
YPe o. �€�caion deRttC?,,,�
Produced Produced >�`%�a'?. ANG
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o n -Oa' �i� o ary Public.
Notary Public-State of FI ° I Gammission . ( r
Commrssr `h FF 2 � I` Commission�o,��_� Sea
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My Comm.Expires May 27,2019 Sondedtftrougfr r.. �ida
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