HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: `7 110 r -I Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772) 4624553 Fax: (772) 462-1578
Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the lend of line
Address;
ED -IMPROVEMENT LOCATION:
Legal Description: % a VO -W on Ul- VC -1- L'- -V\V11 _ -Q__2(_>✓
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Property Tax ID #: I CJ 11
Site Plan Name: 1 \
Project Name: se'r
Setbacks Front Back:
A 2 -
DETAILED DESCRIPTION OF WORK:
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2- 000 -Z
Right Side: Left Side:
7
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or LoT " CM
Lot No. 6 I
Block No. -7-7
CONSTRUCTION INFORMATION:
Additional work to be nertormed under this permit -check all =apply:
❑HVAC Gas Tank ❑Gas Piping _ Shutters Windows/Doors
Electric ❑ Plumbing []:Sprinklers FIGenerator ❑ Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $2,
S Ft. of First Floor:
Utilities:USewer 0Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name V�of-o \_lA o.nr
Name:
i'^i OPV»
Ggt,,�—case
Address: 790D. r4 ��� 1���l�l•
City: State: R_
Zip Code: 73-A 9 51 Fax:
Phone No. �7�� _ 579Y— 5952
E -Mail:
Company:
Address:
City:
Zip Code:
Phone No.
Ib0�
State: 's L
Fax: %72.--Tq4-1 :S q0
7 7 Z - 7I,3 q- / S8
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: A
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
FRONT
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: I _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Phone:
Zip: p• Phone:'
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City: I
Zip: Phone:
I
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 the permit nolgerito owia the suojecr 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 Amendmeits.
The following building permit applications are exempt from undergoing a full concurrency review: doom 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 your Notice of Commencement.
as Agent for owner
STATE OF FLORIDA f STATE OF FLORIDA
COUNTY OF c �T�I�C' 4�E COUNTY OF
The f r oing Inst ment w s acknowledg 4,4,e ore me The forgoing instrument as ac IIkr
this TT day of 201 y this IL day of I
(Name of person acknowledging)
State of Florida
Personally Known OR Produced Identification
entl +cation Produced
edbefore me
20�by
v - —
tary Public- State of Florida )I I
Personally Known OR Produced Identification
Commis s' n 0„ Commis Q�` o.`�: ANGELA M HUF
LA M HU15
FF =N a ry I� +c State of Florida
Notary Public -State of Florida 1� =.F 9 0; GOmmission F
4 fr
91N , a „ z` Commission # FF 234730 '"� " xpires Ma h?
—' Boded rhro�t Y 27, 2019
Revised bar2� Comm. Expires May 27, 2019 �. ;,` _ 9h Nati°nal I otar
ded throe^,it National Nrr n• nc YAss
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