HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Permit Number:
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Building Permit Application Y zolz'
Planning and Development Services r7t
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 �Uj
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential ,
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line Si ' ``a `runty, FL
PROPOSED IMPROVEMENT LOCATIONoc
Address l�C� c',�C' ���� L, 31-(95
Legal Description: ; I R,C' L-C1 1 I
Property Tax l l)#%�119 ,'DQ Qb 3 1 tp c) IK Lot No. l
Site Plan Name: Block No. 13t-
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED:_DESCRIPTldl Or WORK:
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' ►�s�ll„�� Ge�'o� �-t��c'�c C`irteo SocA�, off' -�v,.�pc�c,��
CONSTRUCTION INFORMATION:
i lona war to Orme under this permit-check a appy:
HVAC 1JGas Tank FGas Piping _Shutters til Windows/Doors
Electric Plumbing Sprinklers Generator M Roof Roof pitch
Total Sq.Ft of Construction: .Ft.of First Floor:
Cost of Construction:$ _ Utilities: Sewer Septic Building Height:
OWNERAESSEE :CONTRACTOR
Name ' a Name: MQ:k .LAI
Address: 1-70 i�i,f7Ce 1 1 + Company: 1;L.+ rla
City: ?-SL- State:'- Address:
Zip Code: 450 Fax:, City: F-t>r-k 1�, P State:FL.
Phone No.-7r70- `l 75—Cp?33_ Zip Code: 3q 9 90 Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on neat page(If different E-Mail: Q C�uci1',i., �- ,c @ �rrn,r.C_=
from the Owner listed above) State or County Ucense:
If value of construction is$2.500 or more,a RECORDED Notice of Commencement Is required.
SUPPLEMENTAL CONSTRUCTiON-,LIEN LAIN INFORMATK}N.
DESIGNER/ENGINEER: __ Not Applicable MORTGAGE COMPANY: _-Not Applicable
Name: Name•
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLEHOLDER: ,_-,_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 makes no represent tion that is granting a permit will aut(�orize the ermit holder to build the subject structure
which is in con ict with anYY pplicab�e Home Owners Association ruses,by�aws ran covenants that may r trio or prohibit such
structure.Please consult wit your Home Owners Association and review your feed or 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
coraWidicing worWor recordiniz your Notice of Commencement
s
gg—ndfureW Owner L ssee Contractor as Agent for Owner Signature-of Contrador/License Ho der
STATE OF FLORID STATE OF FLORIDA
COUNTY OF -St - 1yr_; COUNTY OF ( c i • L�cc ,
The forgoing instrument was acknowledged before me The forgoing Instrument was acknowledged before me
this,=day of +�;� �, 20 _C ,,by this_j_4Sday of t I A4 .20 17 by
(Name of person acknowl dging) (Name of person acknowi dging)
(Signature of Notary Publf -State of Florida) (Signature of Notary Public-State of Florida)
Personally Known R Produced identification Personally KnownOR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No.�,��'�jy�ri G -l7, (Seal) Commission No._C-:e=UPQL-C7 (Seal)
� • GABRIELLE HICKS .sT�"°4 GABRIELLE HICKS
Revised 07/15/2014 ' �iy COMMISSION#GG 069047 ?:R MY COM
MISSION#GG 069047
REVIEWS FRONT ' VEGETATtON m' u,
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