HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPlCATION TO BE ACCEPTED
Date: IUD lig Permit Number: g 0 C1" o 5R9
.
'->ry '! Budding Permit Application
Planning and Development Services
Building and code Regulation Division 'f
2300 Virginia Avenue,Fort Pierce Ft 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential ttt///
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
'iPRO'POSD_ VPOVE4EN [QcAHg
Address: 3g Cr1 ' ftAO ( Q, ff
ferce, .L 34C5/ j
Legal Description:5 Sb LQ nUale
Property Tax ID It: J 3 0(0 Ili-oo b)-0w /o Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
R M 4 v'3
DETAI„.El;YDESCRIPTICIN OF WORT{
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ONSTRIJCTION INFOR IIATIOI�I , J s•-
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Additi al work to be L�ertormed under this.permit—check all apply:
HVAC _Gas Tank ❑Gas Piping Shutters aWindows/Doors f
[l
Electric 0 Plumbing ESprinklers i 1 Generator [Roof j ,
1
Total Sq.Ft of Construction: S .Ft.of First Floor:
Cost of Construction:$ 41 oO•00 Utilities: Sewer ElSeptic Building Height
Ok 4thNER/LESSEE- � rA ,', � CONTRACTOR R � ,
Name 0 Name: 1¢J
Address:: 3Qq 1 Clint c,ro,0 U I- company 1t Mr aiyit 170,it ,
�A
City: 6) 'b in�� State: Address: 5i NTUfi tc2, -
Zip Code:, Fax: A City: i
�� ���1e.1(t2. State:
Phone No. 1.2.01 83) =54494 Zip Code:_514(16t Fax11)- Ltf,-31 i
E-Mail: O R.. Phone No:713. 4C I-41,41.
Fill in fee simple Title Holder on next page(if different E-Mail: boy'eat 66. cbn l
t l___
, from the Owner listed.above) State or County License: CACI$I RI$(42
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
I
SUPPLEMENTAL CONSTRucnON LIEN LAW INFORMATION_ SII
,
Name:
Address:
City_ State:
Zip: Phone:
MORTGAGE COMPANY: , Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable I BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Zip: Phone:
Name.—
Address:
ame_Address:
Zip:
1 certify that no work or installation has commenced prior to the issuance of a permit_
St. Lucie CounttBflyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
structure-ctis co Please consuR any applicable
HomemOwne OwnersAssociation nd revinilesew your aws deed for acovenants
y restrictions which may apply.ct or prohibit such
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in Your paying twice for
improvements to your property. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
Signature of Owner ent/ ee Signature of Contractor/License HoldeY
STATE OF FLORIDA `r ".r^ , STATE OF FLORIDA 4 L
COUNTY OF LWT / COUNTY OF �1�
The forgoing insipiment was acknowledged before me The f rgo�ing instrument was acknowledged before me
this ay of 20 � by C this Kday, of.�p 20 B by I
I$
hl({Gulp( � & o, micv t F Boy[a,
(Name of person acknowledging) (Name of person ack(nnoowle igiiinng))
(/Sig
naattare of Nota blit- State of Florida) (Signature of Nota ublic- State of Florida)
Type of
Notary Public -State of F7:n iva
Ca aminxion # GG(419 e
My Comm. Expires Aug 21, 2020
Revised 07/15/2014
Type
Commission # GG 0178n e
� Gomm. Expires Aug 21,
Ided through National Notary Assn.
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