HomeMy WebLinkAboutBuilding Permit Application i
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Yj
Date: IL �' �:� Permit Number: ! 0 WS
Building Permit Application.
Planning and Development Services JUL i at'
Building and Code.Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial ReSidentla�' L'��`�` "�'`> � `
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line r
PROPOSEDIMPROVEMENT LOCATION',..
Address: e)0M`bC)r-> i\fV--
Legal Description: Qq hL-k - SQ LC5-T c4
Property Tax ID#1:,3L4t2—(-Q l u'00%5a—C)oCO—.g Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks' Front Back: Right Side: Left Side:
DETAILED.DESCRiPT(ON OF WORK:
22-6`
L.0 C'ib, NFORMi4TlON.:::: .
ona war a orme under s permit—c a appy:
(JHVAC UGas Tank Gas Piping _,Shutters Windows/Doors
Electric Q Plumbing U Sprinklers U Generator Roof Roof pitch
Total Sq.Ft of Construction: So.Ft.of First Floor:
Cost of Construction:$ E. Utilities USewer Septic Building Height:
OWNER/LESSEE::. :CONTRACTOR.. .
Name c' Name' �2=u;n
Address: M Company: QtAl;4,
..S—
city: k State: Address: )CL5 go�,±
Zlp Code:3L1_92a Fax: City: Fpr -. State:R....
Phone No. 2C>!-- ) g�2 Zip Code: 3g(7 9,;) Fax:
E-Mail: Phone No.'-7"7a- - q�10-7
Fill in fee simple Title Holder on next page(if different E-Mail: Q[ a 1',i•.,
from the owner listed above) State or County License:- [�T6,,4-,
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION.LIEN LAW INFORMATION.
pp MORTGAGE COMPANY:
DESIGNER/ENGINEER: Not Applicable Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
iZip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _._._Not Applicable BONDING COMPANY: Not Applicable
Name: 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 make no represent tion that is granting a permit Gill authorize the permit holder to build the subject structure
w(iich is in conflict witt any pplicabre Home Owners Association rules,bylaws car an covenants that may re trict or prohibit such
structure.Please consult wit your Home Owners Association and review your deed for any restrictions whic�i may apply.
In consideration of the granting of this requested permit,i do hereby agree that l 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 recordina your Notice of Commencement.
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Slgnat re of Owner essee Contractor as Agent for Owner Signa re of Contra r License Holder
STATE OF FLORIDA STATE OF FLOIWA
COUNTY OF A,r f�-e COUNTY OF--- `d"4__LL4c. -e—
The forgoing Insumment was acknowledged before me The forgoing instrument was acknowledged before me
thlsi�day of„� . 20 LZ.by this„day ofC�, n<-e .20 1'7 by
2;1��S '' ++ _ eJ�nL
(Name operson acknowle Ing) (Na erson aekn edging)
(Signature of Notary Public-State of Florida} (Signature of Notary Public-kate of Florida)
Personally Known 1 OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission - 47 (Seal) Commission No.G Q(6qLLfT (Seal)
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Revised 07/15/20 ,��'' , G�18R1ELLE HICKS GABRIELLE HICKS
� ��"���''= MY COMMISSION#GG 469047
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