HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED `
Date:` Permit Number:
s R E C E 1'.' D Ali& 15 2017
INS
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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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
„PROPOSE/D,IMP,ROVEMENT LOCATION, , -
Address:
Legal Description: J_nA;an i�tv r 1:� -1P_� —l,i(l�f n9 �'u�l� ? L(7'1 If2d
Property Tax ID M v'-I,S� - Co (0 - 06,D 0 -dtX - -7 Lot No. C9
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
D: TAILED DESCRIPTION OF WORK
CONSTRUCTION INfORMi4TION ::
-Additional work to be nartormedun er t is permit-check a appy:
❑HVAC Gas Tank Gas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing 17 Sprinklers U Generator F. Roof Roof pitch
Total Sq.Ft of Construction: _/ 6c) S .Ft.of First Floor:
Cost of Construction:$ c� 5C7'' Utilities:[]Sewer 0 Septic Building Height:
OSNNERiLESSEE. CONTRACTOR
Name oxn n n P or-or-n Name: M,2 k
Address Company: a QjIn 1,4,,
City: P-oc-F i.e__C-r 7- State:FL Address: IC`s Go-t- IQ45—i
Zip Code: 3 cl 9 8, Fax: City: FLyl- lis-a-r- P State:PL_
Phone No. :cS IT- Ga I - 00gl , Zip Code: 3,I9RLa Fax:
E-Mail: Phone No--7-7a-asa - 1190-7
Fill in fee simple Title Holder on next page{N different E-Mail:g'u q V,4.,
from the Owner listed above) State or County license: aLo g�
If value 0f construction Is$2500 or more,a RECORDED Notice of Commencement Is required.
SUPPLEIIIENTAL CONSTRLIqlPff LIEN:LAIN INF RMAT OW... .
DESIGNER ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City:, State:
Zip: 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 L cie Goun%ty makees��no represent tion that is granting a pqermit v�1111 authorize the permit holder to build the subjects ructure
w{�I Is In conflict wit1�an ppilm le Home Owners Association rules,bylaws gr an covenants that may restrict or prSibit such
structure.Please,consult w t�your Home Owners Association and review your deed 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 pians,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
con nein work or recordina vour Notice of Commencement.
S
Sign tore of Owner essee Contractor as Agent for Owner Ign tore a Contract r License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF._ SA• Luc:"a COUNTY OF-_ 64 .
The forgoing instrunt was acknowledged before me The forgoing instrument was acknowledged before me
this /3 day of �G- . 20 -?by this, t) day of .4uck __,20 by
(Name of person acknowledging, (Name of person acknowle ging)
(Signature of Notary Public-fttei of Florida} (Signature of Notary Public-State of Florida}
Personally Known. 0 Produced P oduced Identification Personally KnownR Produced identification
Type of Identification Produced Type of Identification Produced
Commission No. � C- Q(n!� o 47 (Seal) Commission No. (-,Q C,0 OC4^7 (Seal)
Revised 07/1 GABRIELLE HICKSr,��,n; ,, GABRIELLE HICKS
COMMISSION#GG 069447 *; i; MY COMMISSION#GG 069047
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REVIEWS SOR PLANS �VE 2&2=44400 OVE
I REVIEW REVIEW REVIEW REVIEW
DATE
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