HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ` �� T— Permit Number:
Building Permit Application DEC 13 2017
Planning and DevelopmentSer0ces PEER",IITTING
Building and Code Regulation Division i. L !e C���ty, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential _
PERMIT APPLICATION FOR: To Select from dropbox, dick arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: �L 3L4c6l Z `
Legal Description: !n `oq `11U� � iii sec ii,S ShOwyl I Vl nr Z��� �q )� h i nU 1 U t
Property Tax ID#: 13 U — — Lot No. 2
Site Plan Name: Block No.�_
Project Name:
Setbacks Front Back: Right.Side:, Left Side:
DETAILED DESCRIPTION OF WORK:
4m
a
CONSTRUCTION INFORMATION:
Additional work to b rformedunder tis permit—check all that apply:
r
HVAC Gas Tank Gas Piping _Shutters Q Windows/Doors
Electric Plumbing Sprinklers Generator Roof
Total Sq.Ft of Construction: Ft.of First Floor:
Cost of Construction:$ Utilities: Sewer 11 Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name 1, r T iITICb 5 Name: a ' C
Address: I , Y'► T Company: 14, cr
City: t" P,t rLe_ .,ktate: L Address: 3 E c4r e_ yr; /'C�! if d
Zip Code: 14 C(� Fax: City: Stat��e``:_zSc—
Phone No. '�`] 2 7 U--3 L u Zip Code:,3 i'O Fax:
E-Mail: (\// 0 Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: X
from the Owner listed above) State or Coun icense:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
licable WIORTGAGE COMPANY:
Not Appli�ble
Nat App� Name:
DESIGNE ENGINEER: Address State:
Name: _—
Name: State: city: Phone:
Address: zip:�----- Not Applicable
city' Phone:
zip' ►stable BONDING COMPANY:
��}IpLpER:: _Not App Name:
FEE SIMPLE Address:
Name: may;
Adder: Phone:
Tap:
city: Phone:
Phone'
Zip:
prior to the issnanre of a perm ft the subs structure
1 Gefgy that no work or installation has commenced p it holder to bind est or prohibit such
contwits,bylaws or a �enjrst that which may apply-
tion that is Scanting a pe on rules,bylaws or an eov restnd>Ions
Assoc
St.Lucie Coung� air pl��ca�Home Owners wauoandand review your deed for any ,perform�e work
which in co e.Please�ruuR your Home Owners Assoc that 1 will,in enc ern
in consideration r,ting of this requ�ed permit,l do herebV39ree a Courrty
of the gra 8ulkiing Codes and St.I.ud additions,
in air with the approved plans' FloridaFlO a fuN concurrencY renew:room
t from undergoing another non-c�dl use
aPplicattons are exempt sa�roomsand accessory uses to twice for
The followingbuilding Permit Pp:a fences,walls,signs, result in your�Mg
accessory structures,swi rs posted on the jobsite
'�' nreoorded and po omeY before
WARNINGTO OWNER:Yourprope allure A Not of�to Record �a conte with lender or an aft
improvements to your p n If You intend to obtain finana g,
before the first insPe�o ' our Notice of Commencerfient.
work or recordin
comme
tute of Contractor
of O+M / STATE OF FLORIDA
STATE OF FLORIDA COUNTY DF
before rcie
COUNTY TI►e M���by
before"�
The Instrument was adcnaw -lee 0 by tfiis
thisfi�of
1ppwledging)
(Name of Person
(Name of PWolted6b�� c>----
Si of Nary pub -State of Florida)
(�gnature of Notary Public She of Florida) personalty Known _OR produced L lcatlofl '-----
tion - of lde� O^Produced
Personally Known OR produced t11Pe ��
Type of Ideon
KAVOCS. NIELSEN n
CbMFn1ssJ No. - _ Commission # FF 11563/ r mission SEN E
ae My Commission --m ;� `< °w;°o' My Commis oaf 15637
2018 June 72 Expi.es
Revised 0711512p14SEA tURT1E MANG
ETATRO
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DATE
COMPLETE
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