HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE NFO S�jT BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /'� 3® 26 Permit Number:
NAHUM
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 11
PROPOSED IMPROVEMENT LOCATION:
Address: 2/7 6)CP(nil 13,y 0,ve ,%PnSp^ /iPv,c: L /--L 3 V 95 7
Legal Description: /AS
Property Tax ID #: 3 S Z Z (� Op – Of7s —OOH Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back:
Right Side: Left Side:
I DETAILED DESCRIPTION OF WORK: III
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I CONSTRUCTION INFORMATION: III
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HVAC LGas Tank LJGas Piping
Chlectric El Plumbing 05prinl
Total Sq. Ft of Construction: Z 6 fr-2
Cost of Construction: $
Shutters Windows/Doors
Generator Roof = Roof pitch
5Ft. of First Floor:
Utilities: Sewer Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name it 0M9S
Name:
)roLLD
Address:/6 373 Sc✓ 63'd %er
Company:
/9-C
City: A ,0,— � State: F t
Zip Code: 33 /q 3 Fax:
Phone No. 7 $b 417 0 003
Address:
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City: %/0—PA
Zip Code:
Phone No.
I o FeAc 1, State: F–(–
i33(J6 5 Fax:
9 S `% 9' 3 9 75 /7
E -Mail:
Fill in fee simple Title Holder on next page l if different
from the Owner listed above)
E -Mail:
13O^ e s mac+ G
State or County License: Cf% C / 8- / d'/
it value of construction Is 52500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
_Not Applicable
MORTGAGE COMPANY:
Name:
Not Applicable
Address:
COUNTY OFSTATE
Address:
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City:
Zip: Phone
State: _
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
Type of Identification
Address:
Produced
City:
VES
City:
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Commission No`s O '•;�° N GG
Zip: Phone:
fission Nob' CO(�M.MI39101Y i GG07e278
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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 ermit holder to build the subject structure
structure. Please consult with your Home Owners Association andrreview your deed for any restrictions which ma y prohibit such
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
d' Notice of Commencement
COmmen Cln COr, In our O
S' nature of Owner/ Les a Co ractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
OF Fl.ORIDA B�owa�(✓
COUNggTppYOF �$5�`�a� n/
COUNTY OFSTATE
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7;�O it C ke
Name of pen ng statement
Name of person Tqlang statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identifialtion
Type of Identification
Produced L.
Produced
ature ofotary Public- S a
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VES
ature of Nota a
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Commission No`s O '•;�° N GG
fission Nob' CO(�M.MI39101Y i GG07e278
gFCOMMISSION
EXPIRES Ma ph 01,
1
EXPIRES Mlmh 01, 2021
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17