HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE I pFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /0 /0 Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation, Division
2300 Viraioio 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 IMPROVEMEN/T/ LOCATION:
Address D7 K�'�><v aer-F S� Luue FL 3y�87
Legal Description: QEQV 4CIR C- S 6K 2 L07-2-1—
Property Tax ID 4:�-l_ _ J __. _ Lot No.
Site Plan Name: _ Block No.
Project Name: E_
Setbacks Front Back: Right Side: _ _ Left Side:
DETAILED DESCRIPTION OF WORK: _ _ —
Ae&VVY arw hp la ee S r.v .4,r 114,,elle f- Q�a' �o.�c��s� ly 5_5&er
No &cc fiplacewh >L A -(Z 150 033`
No lie kc 410'G4'�#uon � loXw A&
CONSTRUCTION INFORMATION:
A itiona wwork to be erform- etc -un er t is permit- cTecTc all tf� appy:
®HVAC 1 Gas Tank ❑Gas Piping E Shutters Windows/Doors
Electric ❑Plumbing ESprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: ')Z3�J� S Ft. of First Floor:
Cost of Construction: $ w Utilities: Sewer 0 Septic Building Height:
OWNER/LESSEE:
'_/ — CONTRACTOR:
i�ameJe rlrl Name: 3`D,CI�tf.� Ayu I
Ai Company: l�•"fl/ R�✓� i Company: (/Ctl/ �li�tq
City: Por - 5L_4 State: i Address: PO L3 ex 7? ? �
I
Zip Code: if7 Fax: ------- i City:!"ssn0r _ State: FL
Phone No. 9701 6lo Zd' _ Zip Code: 3`195 r Fax:
/9S�/ 333 ��Yo
E -Mail: Phone No. 9�y �Z o137
Fill in fee simple Title Holder on next page if different j E -Mail: C G C� �QUuI%t/ • LOr1'I
from the Owner listed above) State or County License: le/7 L!S
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: — Not Applicable
Name: '
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
_
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
1 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 with lender or an attorney before
commencing work or recording our Notice of Commencement. —_
S
Sigr ature of weer Lessee/Contractor as Agent for Owner Si ture of Contractor/Lic nse Holder
STATE OF FLOR STATE OF FLORID
COUNTY OF �-�--oc+�- COUNTY OF J J u -c— -
The forgoing instrument was acknowledged before me
this11>) day of20)jiby
of perr�on acknowledging
otary Public -
Personally Known ORP
Type of Identification Produced_
Commission No.
:_D3Iow�
Revised 07/1
W
R961380 HOUGH
Notary Public - State of Florida
My Comm. Expires Aug 4, 2019
The forgoing instrument was acknowledged before me
this 1 day of ) J, �A 20 by
of person acknowledging)
of Notary Public- State
Personally Known OR ProducedI entificatior __
Type of Identification Produced CL._ ne ► r
Commission No. �1
RACHEL A HOUGH
o" 3) {� '_°* • ° c Nnrar - tate of Florida
" " = Commission # FF 231005
'ilE nr 50My Comm. Expires Aug 4, 2019
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