HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 4/ ��®�� Permit Number:
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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
PROPOSED IMPROVEMENT LOCATION:
Address: '_�p /
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o 5lT-5�2
Legal Description: V /S7-14 S i L-0 C / E" i3 Lb 6- _2 / /.e iU %"T / U %
rr39--1Q L291c1:a9-51-.2779-7
Property Tax ID #: 3'42,2 - 500 _ 0,�,l ?w7 '—O 0Q " S Lot No.
Site Plan Name:
Project Name: Hol, C uf)Q eL C L-4—
Setbacks Front Back: Right Side: Left Side:
Block No.
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additional work toe performed un er t is permit - check a appy:
MHVAC I_1 Gas Tank ❑Gas Piping _ Shutters a Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ `� .10 -- Utilities: _ Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name S+J2_v `V or)
Name: Fre.-Cid I
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A
Address: �Q_I�L%-VI'`Jaya C��7
Company:
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City: P(WT + - Lue 1e, State: VC.--
Zip Code: -- P Fax:
Phone No.
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Address: 19 .
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City: R) r - S+. ( .1t,4f_ State: fJ C
Zip Code: Fax:
Phone No.
E -Mail: " r-1 c� Q( A f- L' A- e- 00 a+i , r)e."f"
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License: 0 fA 0, 1 1 UQU3
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
v
DESIGNER/ENGINEER: 'Not Applicable
Name:
MORTGAGE COMPANY: V/' Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
r
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: vNot Applicable
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 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 wit u lender or an ,attorney before
commenci g work or recording vour Notice of Commencement. I(i I I
STATE OF ILCIAIDA STATE OF Fl.
COUNTY OF r`,u 04 i_C! '' COUNTY OF
The forgoing instrur ent nras acknowledged before me
this day of ) 20by
ng )
(Sigr(ature Of Notary Public- State of Florida )
Personally KnownOR Produced Identification
Type of IdentificatAPProucedIS IML GIL -
Commission*COMMISSION#FF 914194
AIRES: August 30, 2919
BonAdThru8W0NftyWft
Revised 07/15/2014
N
The forgoing instruqien was acknowledge._before me
this day of I 20 uc by
edging )
(Signatur,p`of N,htary Public- State of Florida )
fully Known-4-0
nown-4— OR Produced Identification
of Identification Produced
Commission Nor/'G% / 1 AWNISABELGIL
* * �IY COMMISSION # FF 914
,1 EXPIRES: August 30, 20
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