HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:�Z C? o 4,v 0
Building Permit Application
Planning and Development Services JAN 18 2018
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Res clential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the nd of line
4R.-&1. M� RM
Address:31 Cl_�)dm U'�S+q (we' ro rt P t-'re'-f- E I
Legal Description: mcr"iwq Wrs' 4W C'
Property Tax ID#:a4 �-g -(0 6 1 q-06'b-(d Lot No.
Site Plan Name: Block No.
Project Name:- 1G t4,. <d M LR cdt'\
Setbacks Front Back: Right Side: Left Side:
RKT11'
Qk-CLOO(M r)os I ix_cpoet-e_ D C9-v J;a
HVAC L.—!Gas Tank Gas Piping _Shutters ( Windows/Doors
Electric Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: SCI. Ft.of First Floor:
Cost of Construction:$ - Utilities: Sewer F_1 Septic Building Height:
2
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Nameetdd5 rml
'0J +qdf,� Name:"._.)a%i4 ",k.1 — _Q40r-k
Address: Company-'_ '4_(o OCA�-O-efo__ t-C":V
City: State: Address: 6 24 3":Ji 0F'L)
Zip Code: Fax: city: Iki `ffikY2 state:
Phone No. 77&— Pt;L_6qV) Zip Code:33i-1 I D— i Fax:
CONnfl Phone No. 5-clo 1 0
Fill in fee simple Title Holder on next-page(if different E-Mail:
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement Is required.
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPAN ^Not Applicable
Name: Name:
i Address: Address:
City: State: City: I 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.Lucie Countv makes no representation that is granting a permit will authorize theermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and pcovenants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for any rest fictions which may apply.
In consideration of the granting of this requested permit,I do hereby agree that I will,in all resp cts,perform the work
in accordance with the approved plans,the Florida Building Codes and St. Lucie County Amendm nts.
The following building permit applications are exempt from undergoing a full concurrency revie : room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to a other non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may resu t in your paying twice for
improvements to your property. A Notice of Commencement must be recorded nd posted on the jobsite
before the first inspection. If you intend to obtain financing,consult with lender r an attorney before
commencing work or recording our Notice of Commencement.
KVLJ— a- _t4'_t2_ -_ ^I s
_Signature of Owner/Lessee/Agent Wature of Contractor
JLicensp Holder
STATE OF FLO IDA. STATE OF FLORIPA
COUNTY OF elflA I-5 COUNTY OF _
The forging instrument was acknowledged before me The forgoing instrument was acknowledged�pbefore me
this_S�!day of _\&nvcy-t_x20 by this -day of �_ 20 _L�by
/V�Cho 1415 (A 54a
)LqM1_9'S'f1 T)o ils
(Name of person acknowledging) (Name of person acknowledge g)
(Signature of Notary Public-State of Florida} (Signatu of Nota Pubir State of Florida}
Personally Known.1- OR Produced Identification Personally Known !O OR Produced Identification
Type of Identification Producedyp ✓e ANGEiAYOUNG
T e of Identification Producer.°' �
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Commission No. _ MISSION#FF 956732
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Revised 07/15/2014
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