HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE IN cl MUST BE COMPLETED,FOR APPLICATION TO BE ACCEPTS —1
Date: Permit Number: t"'01�
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RECEIVE®
Building Permit ApplicatioF
JUL '018
Planning and Development Services ucie CUuf�tyf ii iC ii IngBuilding 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 ctd
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Lego!Description:s.SIA n�'l �b LL�� P -
Property Tax ID#: 35 3 S`3 3Y-QQ0 3"a a0_S Lot No.
Site Plan Name: r _ n(-r(S Block No,
Project Name:
Setbacks Front Back: Right Side: Left Side:
NAM,
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Additionalor to e e orme un er t is permit—c ec a appy:
HVAC Gas Tank ❑Gas Piping _Shutters a.Windows/.Doors _ -
Electric Plumbing Sprinklers Generator Roof
Total Sq.Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ � 8, d�3 Utilities: Septic Building Height:
Name:
Name fl c r-i�
Address:Q* 140-7 5 QGCaia 06m, cialf l A company.— 4-Co
City:At'c)sr n Bwc k State:F Address: t �� '7 Tfi
Zip Code:. gce-57 Fax: City: l ,L), - -State:_F,--
Phone No.S7 t `3(of 3(,gLe Zip Code Jay I a— Fax: J Zrl - FJ S~-efoJ
E-Mail: Phone No. 5` !9 OS'�
Fill in fee simple Title Holder on next page(if different E-Mail: �,
from the Owner listed above) State or County License: C �� C- - 3
If value of construction is$2500 or more,a RECORDED Notice of Commencement Is required.
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DESIGNER/ENGINEER: 4 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: X 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 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,
accessary structures,swimming pools,fences,walls,signs,screen roorms aril 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 b&-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 our Notice of Commencement.
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Signature of Ow er/Lessee/Agent 3pffure of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORID
COUNTY OF- Marrl n COUNTY OF Phleko 9,061 ch
The f piling instru�!en�t�w_as acknowledged before me The forgoing instrument was acknowledge fore me
this day of—r I 1 Y l U 4, 20&-by this_4� day of
.20 Jrby
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n —n a of person acknowledging) (Name of person acknowledging}�
tore of Notary Public- tate Florida} (Signator of Nota Public- tate of Florida)
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Pis nally Known OR Produced Identification D�j
� Personally Known__-LZOR Produced Identification
f Identification Produced_f`L OL Type of Identification Produced
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fission No. -IG 3 2 (Seal) Commission No. AV Puq (Undi}AYOUNG
# * MY COMMISSION 9 FF 951069
PXPiRES:April 12,202D
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Revised 07/15/2014
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INITIALS