HomeMy WebLinkAboutBUILDING PERMIT ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �d'-�7 Permit Number:
oullming rerma Appillcavon
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
PF-KMI I APPLICA I ION FOR: To Select from dropbox, click arrow at the end of line
PROPC)SED IMPKUVF-MF-N I LUCAI ION:
Address: 419✓ ,0 Al A I A teZy�
Legal Description:
Property Tax ID#: H9 3- 50-p(11O2 -C11Dr 7. Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DE I AILED Dt5C:KIP I ION OF WORK: I
CONSTRUCTION INFORMATION:
-
Additia—on-f worrk tod eb erformed un er I h is permit-c h ec k a app y:
0HVAC Gas Tank [:]GGas Piping _Shutters a Windows/Doors
11 Electric Plumbing Sprinklers El Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ 3 Utilities: F1 Sewer MSeptic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name 8 u z a, RD b¢ Name: GUrQTt S ,SpMv�cnS
Address: PO d bX I13 q Com pany: L.5-ro m A , r S u S&ems (ru c=
City: R ii& State:44 Address: -t r ee r,
Zip Code: 1W Fax: City: PC)2T 9t. L uc(,r- State:Phone No. da4-4Wr7-3GO Zip Code: a+q5' Fax: `77a J35-196�
E-Mail: Phone No. Vi l a- 3 3 S - 3 2 3 Z
Fill in fee simple Title Holder on next page if different E-Mail: C LA S t c1 I r 5 y , Cc o C(,VM
from the Owner listed above) State or County License: C° C O 5( F I C
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If Value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENIAL CONS I RUC IION LIEN LAW INFC)KMAIION:
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: 3
I
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 re c , ding your Notice of Commencement.
s
Signature of Owner/ essee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA r / STATE OF FLORIDA
COUNTY OF �J r(.U C`l E COUNTY OF
The forgoing instrument was acknowledged efore me The forgoing instrument was acknowledged before me j
this al day of f 20l/by this 'today of 20 ( by
- Liu r fl; 14 fn coon S' u rzrl S
snmM0n S .
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Fl a) (Signature of Notary Public-Stat of Flor'
Personally Known ✓ OR Produced Identification PersonaNy Known OR Produced Identification
Type of Identification Produced u/ � Type of Identification Produced �j� rye. �
tr!V l O c� ` b !�� VI (1 t/ a�`1 l: •• c4� GHk4�?i� t}
Commission No. aK:��t`f CHRWINEB emission No. nwc K2S16
* * MY COMMISSION/ 05 W )2t
DD'IRES:Apra .202t_
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MY C�FRTsE RFrH E�2Revised 07/15/'014 EM:Aprl 4,a M1�I
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