HomeMy WebLinkAboutScan_0026ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
J -
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34382
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 3% 2--K-t Sk em a (Ac_i1 tr�L,_� Lc,-Ae-- , ,,, L trio W ;w r� �c:-)
Legal Description: C, to tOL CA L� P(r-'c_t�
Property Tax ID #: l ( 0 a -° QQ1 ( -_ X00 �„' Lot No. l
Site Plan Name: Block No. 4t
Project Name:
Setbacks Front Back:
DETAILED DESCRIPTION OF WORK:
Right Side:
CNcu� OUO- 4 ��- PD,
Left Side:
CONSTRUCTION INFORMATION:
Additional wor c e to qer orme under un er this permit- check all apply:
�HVAC Gas Tank E]Gas Piping {r_Shutters l� windows/Doors
Electric Plumbing Sprinklers L II Generator EI Roof Roof pitch
Total Sq. Ft of Construction: S. Ft. of First Floor:
Cost of Construction: $ Utilities:cn Sewer E]Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name o ln
Address: agagq;�4
Name: t
Company: t_t �V� o <�a cv
City: �.--tL�Gt State: f"L.
Zip Code: Eck- Fax:
Phone No. - 77
Address: s� r\
City: pk_UJ_'LCA'P_ State: t--- .
Zip Code: 1_3e1 ( S a Fax:
Phone No. si
E -Mail: f ices(aqn
E -Mail:
Fill in fee simple Title Holder on next page if different
from the Owner listed above)
State or County License: 1 �L
IT Value OT construction is .yzsuu or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIED LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 the permit 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 your Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA z
COUNTY OF F1-_.
The forgoing instrument was acknowledged before me
this Z_ day of 0- - 20 Eby
1
(Name of pi rson ackr)6wle a'}
,kSignature of Not�ry�irblic- St .te of Florida )
Persown / ification
Type tion roo uced
=' MY COMMMS1iA�1ri
Comm,s. EXPIRES May 21,201?Seal
�4GlIJ4d�'S1 flordaMoa exvka.ear 4
Revised 07/15/2014
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF_ A _Q_
The forgoing instrument was acknowledged before me
this day of i � , 20 l� by
(Name q�pers ack edgi ,��
(Signature of Notary uyic- State of Florida }
Person n Ilaf#d2Rt fication
Type o .e- tiMY CBiVJMcfS
Commi s EXPIRES May 2`11. 20119 1}
iIG11 aIM1i' 3 .cart
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