HomeMy WebLinkAboutScan_0049ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: J Permit Number:
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
��
Address: 2 5 SL' i r,� �1 y A. 'PC 1. , i
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Side: Left Side:
Residential >C
Lot No.
Block No.
DETAILED DESCRIPTION OF W( ORK: r }
1(0 See r
CONSTRUCTION INFORMATION:
Additional work to brtormed under tispermit—check all that appy:
�]Gas
HVAC Tank ❑Gas Piping _ Shutters Q Windows/Doors
11 Electric 0 Plumbing Sprinklers Generator L1 Roof Roof pitch
Total Sq. Ft of Construction: SnSew'eroSeptic
of Frst Floor:
CostafConstruction:$ °-(.15CJ.G� Utilities:Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Leor A t G1•c ,,A ujin-ee(er
Address:_Sag- Wil+
City: P,!5 C_ State:/
Zip Code: 6L(cl $ Fax:
Phone No.
Name: jml el'ioel MQZ-7111,
Company: %i-115SYt,e-Fy,ngk�l
Address: icoi 5L, 0t, �
City: -ALL,, _
Zip Code: 2i'i'( Li
Phone No(:7 7D-)
E -Mail:
State ; C
Fax:
tF�, l c. �► -: C
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or ounty License:
0-ACI-fS d 7&1&
If value of construction is $25W or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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. Lucie County makes no representation that is granting a Permit will authorize thepermit 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 vour Notice of Commencement.
s
as Agent for Owner gignature of Contractor o er
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF C {" COUNTY OF D_\(.tti -.
The forgoing instrument was acknowledged�efore me The forgoing instrument was acknowledged before me
this, day of rv�+�ctsv� 20 Eby this 1Z day of ;Y\AcL i .20 \'K by
(Name of person acknowledging) (Name of person acknowledging)
5i nature
afore of ptarypubjJc=Stet e;,��`fY��� (g � N�' - ORNE
�p Pyr p ®' U ate �t .,, public - State of Florida
Rota( pu c - S�aI#"e� I oda i °
Personally Known ' Pr�Or? it y ear FF ?�i Personally �`' ed �j#g$tio
Type of Identifi6i Y Type of ld rel _vJ4 2019
" " F {' rough National Notary Assn.
(rded through Nati al Notary Assn
Commission NJCommissior)I.
, ��. �,_ „-
Revised 07/15/2014
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