HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFOMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: / 74 Permit Number:
s
oulliaing rermix Applllcavon
Planning and Development Services
Building and Code Regulation Division J
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential -
PEKMI I APPUC:A I ION I -OK: To Selma from dropbox, click arrow at the end of line
YK(}YUS_E_ll IMPKC)VEMEN I LOC:AI ION:
Address: 3 Q I---� C r -C-- b W oto C -t --
Legal Description:
� �� ' � V ac U Lot No.
Property Tax ID #:
Block No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
LN: IAILEL) UESCRIPI10N tar WO KK:
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CONSTRUCTION INFORMATION:.
Additional worK TO e e rme un er is permit - ch ec a app
]Gas Tank Gas Piping �[]�Vind owsJDoors
_Shutters
HVAC
0 1 Sprinklers 11 Generator � Roof Roof pitch
Electric Plumbing
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
CDSeptic Height:
Cost of Construction: $ 6 6 Utilities: Sewer Building
OWNER/LESSEE:
CONTRACTOR:
Name h., !' !I
Name: C ii ►t Z i Sfq rLIY�C n
Company: �e
l�0 8rrr n 2iJ
Address:
i �C lC State:
Address: 14F,15 S E \Zl I l a4 --C�� r ee n, p
City. ►, �r� I .
Zip Code: i��-�f Fax:
City �v R T St . L uc(State:
Phone No. o�� ! _ y� .9r, -3
Zip Co de: a'f`752- Fax `77� X 35 -i q>ra
E -Mail:
Phone No. i
E -Mail: C u S t r- s s Cc 1 C c. i
FN in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License:
__
if value of construction is $2500 or more, a RECORDED Notice of Commencernent is required.
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SUPPLEM EN i AL CONS I RUC I [ON LIEN LAW I NEURMA I IUN:
DESIGNER/ENGINEER: _ Not Applicable
I MORTGAGE COMPANY: — Not Applicable
Name:
Name: j
Address:address:
City: State:
City: State:
Zip: Phone:
Zip: Phone:
FEE SiMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Applicable
Name:
_Not
Name:
Address:
Address:
City:
City: !
Zip: Phone:
zip: Phone:
I certify that no vrork or installation has commenced prior to the issuance of a permit.
St_ Lucie County makes no representation that is granting a permit XVill authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Ov:,ner s Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult Ah your Home Owners Association and reviews 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 folloriing building permit applications are exemptfrom undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, va`Is, signs, screen rooms and accessoR' uses to another non-residential use
WARN ING 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 your Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for O:vner I Sib ature of Contractor/License Holder
STATE OF FLORIDA j STATE OF FLORIDA
COUNTY OF `. I COUNTY OF
1
The forgoing instrument vias acknowledged before me 1 The forgoing instrument was acknov.1edged before n.e
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this day of7+f by this day of ,rL �� �,�, 20 / by
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(Name of person ackno:rledgmg } ( (Name of person acknovrledging ) !
Ll�_C�-- I ! =fes!/ �/JCt��✓' i
`PUblic-
(Signature Of lUdiary PUt)IIC- State of FiDrli:Td ) I (Signature of Notary State of rlOn(I-�r_y
Personally Kno yn OR Produced Identification Personally Knaam OR Produced Identification
Type of identification Produced_ Type of identification Produced
Commission No_ :7 L°"i �' sJ�y ti '- �, a1',�Cg CHRISTINEBENQttrnission No. L-1!"r (� cl c( J`: �° .•. 4c p _ .: •.'
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