HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLIC4BLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: h Permit Number:
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
PROPOSED IMPROVEMENT LOCATION:'
Address:
Legal Description:
Property Tax lD #: 2303 -all -oo25 - O o o ! 5 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK: I
Lik--For like: Tvtsin.11 nea Nuivyw- 14 lav►, 14- sGei� �, P cay- mit-
lu►�, IoKJ hVat11
I CONSTRUCTION INFORMATION: {III
HVAC
Gas Tank
❑Gas Piping
Name:
H
Shutters
Q Windows/Doors
Electric 0
Plumbing
❑Sprinklers
E -Mail: 64eal @wd cow►
1:1
Generator
1:1
Roof
Total Sq. Ft of Construction: ��r�
Cost of Construction: $ 3 O 0 -60
Sq. Ft. of First Floor: _
Utilities:Sewer E]Septic
Building Height:
OWNER/LESSEE:� caner
CONTRACTOR:
Name M p�061 Q/
Name:
Address:) 3IS4-Ax1fi
_
Company: ifffflLw
Address//: J"A 7W'Yt �drA, r.(.Co12( jjd,
City: O(hii' & e4af,6. 6. State: _
Zip Code:' 3'1,Q f.! Fax:
Phone No, iafltSTi MIA VS -7311- 3R3(r
f1(0)
City: CDI o ,,I at State: rL
Zip Code: 34A51 Fax74Y--14 e4 -31YI
Phone No.-IIJ-4Q(,414 (
E-Mail:91A
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: 64eal @wd cow►
State or County License: ChCMI$ISU
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
Not
Name:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: _
Address:
city: _
Zip: ,
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
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 jobsite
before the first inspection_ if you intend to obtain financing, consult with lender or an attorney before
Signature of Own ent/ ee
STATE OF FLORIDA
COUNTY OF �T 11A1
The forgoing io me M s ick- acknowledged yre�
this � day of g.,� 20 b
M.ic�nae(� �oyl�
(Name of person acknowledging
/?J
(Signature of Notary P ic- State of Florida )
Personally Known V/011 Produced Identification
Type of Idenhficaljo2 P
uro. CHRISTINE J. CONWELL
� of Florida
Commission N o Notal Public f9WIll)
.�; Commission # GG 017839
rxnires Aue 21, 2020
Revised
Axl,
Signature of Contractor/License Holder'
STATE OF FLORIDA Ct l ;�
COUNTY OF *1 Lutl
The forgoing m ment was acknowledged before me
thisgi't—dayof QeCM12CC 20by 0
1$
�IChQQ.� � t3r�yl2�
(Name of person acknowledgi ) -
(Signature of Notary lic- State of Florida )
Personally Known �OR Produced identificati n
Type of
Commission Notary Public - Stpla�o�f�yyFFlorida
fission #0839
My Comm. Expires Aug 21, 202
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