HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: -M Permit Number:
64 ,F
autltaing rermit Application
Planning and Development Services
Building and Code Regulation ,division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 402-1553 Fax: (772) 462-578 Commercial Residential
PEKMI I APPLIC;A I ION FUR: To Select from dropbox, click arrow at the end of line
PRUI'U_StU imPR` vl_MI=N I L_OCAi ION: _
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Address:---------_e2�o2i ,EQQ�'P-d �UR*----
Legal Description,:
Property Tax ID Ir: ®�'r Lot No.
Site Pian Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
UE I AILED UtSC;KiP I ION OF WORK:
I
CONSTRUCTION INFORMATION:
stt a wor to e e orme under this permit — check a apply:
HVAC � Gas T ank []Gas Piping _ Shutters Q Windows/DoorsElectric
LJ Plumbing Sprinklers [] Generator Roof Roof pitch
Totai Sq. Ft of Construction: Sq. Ft. of FirstFloor:
]j
Cost of Construction: j y7�� Utilities: El Sewer 7Septic Building Height
OWNER/LESSEE: j CONTRACTOR:
Name R.Qx Wafkio'-, ?.ono I erg Matfk,W Tri urn$ Name: Uy'T i s Sr-, a,,oAc n S
Address: 41SO E( (0�t., d o 13LCompany: CttS?�rK r �u 5
city: ryi;A'VLt State: FL. Address: l i 5 -S E F �; l i dG r,e'e a
Zip Code: 33133 Fax: City: F02T St L =c State: r-� j
Phone No. J6,57-3o.,7'Lo 6 6 !Zip Code: 3+qS)- Fax: '7'7.7- 9
E -Mail: Phone No. 3:5- - 3 L 3
Fill in fee simple Title Holder on next page ( if different E -Mail: C u S t a i r Cr
from the Owner listed above) State or County License:
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMEN IAL CONS I RUC i10N L IEN LAUD iNFURMA I ION:
DESIGNER/ENGINEER: Not Applicable
—
i
I MORTGAGE COMPANY: — Not Applicable
Name:
j Name:
Address:
' ,address:
City: State:
City: State:
Zip: Phone:
It Zip: Phone: ;
i
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address t
City:
City: I
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 Evill authorize the permit holder to build the subject structure
which is in conflict with any applicable Home O..iners Association rules, bylaws or and covenants that may restrict or prohibit such
'your
structure. Please consult .•nth your Horne Oo nersAssociation and reviewdeed for any restrictions which may apply_
In consideration of the granting of this requested permit, I do hereby agree that 1:will, in all respects, perform the work
in accordance .pith 'the approved pians, the Florida Building Codes and St. Lucie County Amendments.
The follo.king building peni-iit applications are exemptfrom undergoing a full concurrency review: room additions,
accessory structures, svL4m;nino pools, fences, vva`Is, signs, screen rooms and accessonr uses to another non-residentiai 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 flnancing, consult with lender or an attorney before
commencing work or recording your Notice of Commencement.
1 _ 5
Signature of Ov..ier/-esseejCortractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF , " <- _ - (
I
COUNTY OF
The forgoing instrument _vas acknowledged before me 1
The forgoing instrument was acknowledged before me i
!his day of - 20 _' bv I
- 1
this day of 'p by
(Name of person acKRC.?Iedging i I
(Name of person acknov:ledging )
(Signature of Notary Public- State o rscri iz) f
I
(Signature of Notary Public -State of F lon a=}
i
i
Personally Knottirn I, - OR Produced Identification
Personally Known OR Produced Identif 2tiOn
Type of Identi ication Produced l
Type of Identification Produced
Commission No- :%i '; - _ iqY CFfR15tWEBEHC
- yJcY P� CNRIS:u:K. r}li
Ifhmission No- v`: _
MY COMMIS510N * f
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