HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /,,
Date: W?-1V Permit Number: ` 'O(o 13
C 'LINTY
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
PRO:POSED`rIMPROVEMENT�LOCATION ,,,
Address: iCOP-MhaYen 1(211
Legal Description:
Property Tax ID#: 3 I 0001 - 01 O - 3 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORKm � f f
7-n3-tOd2-C ive,t0 I, cade I
CONSTRUCTION IINFORMATION.� - : ..G..:.,_
Additional work to be erformed under this-permit-check all apply:
❑HVAC [1 55 Tank iGas Piping Shutters
rs 1=1Windows/Doors
ElElectric M Plumbing Sprinklers El GeneratorRoof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ Utilities:I Sewer Septic Building Height:
OWNER/LESSEE t
G
Name - r e.L t �:R Name: ('.. .t - i+ F,C-- .•
Addr-ss ;"�(s �, � I� 1Z ! eta, - Ili Company:
City: i � State:
Zip Code / ® Fax: - City: . 9`-e. e, State: '
Phone No.-7 4 O tao-7a Zip Code:0 q Fax: p�• 744 /sa
E-Mail: Phone N•.. /��� /?�,;, -
Fill in fee simple Title Holder on next page(if different E-Mail- I �(�II i1 0M 09 it. w(YL
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTI ON'LIEN LAW INFORMATION - 4 = - ;.
DESIGNER/ENGINEER: _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: _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,
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 jobs-te
before the first inspection. If you intend to obtain financing, consult with lender or an attorney befor-
commencing work or recording your Notice of Commencemen#.
Ain ,,/ /4/1, . 4/
A�': � -C ` ,,,,Arra--< , .r , s
Signatur-,4 Owner/Lessee/Conte; oAgent
for Owner ignature 4 Contractor/Lic- se Holder
STATE OF FLORID STATE OF FLORI /
COUNTY OF j \)SQ— COUNTY OF .,2_,/kta.
The f-pming instrurryent wasiscknowledged #ore me The forgoing instrumentt was acknowledged before me
thi day of ' 'P I , , 20/xj by th' day of6)..91. ,20 J by
�
14_,akeD n Or ` ) /.!1�he(1m
_ e. -' ..
(Nameo, .ersdn acknowledging) (Name of p .on acknowledging)
XAllk 110
i 'N,' k‘n. Ilk. t 1" Imr-iiil i 11 l
-ignature of Notary P -State of lorida) (Si ure o ry P • tate of Florida)S
Personally Known OR Produced Idents tea ion Personally Known Produced Identification
Type - :. ;.. --ca ion Prod - -
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' I,flf COMMISSION A GG Oseg) ,.. , . 'MY �SION EE 871248
Com, Commission No. =*: