HomeMy WebLinkAboutBuilding permitALL APPLICABJE INFO( MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: � I� I � q 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: Qg05 6oe6bu,ir((Le f(, 31-WI45 �(,ce: Deniti5
Legal Description: tSplde.Vl 299 AL M01J 0,10 V l pads
Property Tax lD #: 2303' �2 (( —007-5-000/6 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Si�(� 3 -br1 [u SEep, �ica°(ry
crit W-1/1 10 tcc) head
CONSTRUCTION INFORMATION: III
prnatworKtOriecierrormea
HVA 0 Gas Tank
unser tins
Das
permit— cnecK an
Piping
mat apply:
Shutters
F]
Windows/Doors
Address: BIOS A-Ti.txnyi ICL
City: dz:�RQ(C,2 State:
Zip Code: 3 k Fax:-�17?--4&(a -237
PhoneNo. 770.-4(o
22j
E -Mail: I��A• IsJzaA:
_
E -Mail:
(tsNYl
Electric F-1 Plumbing
Sprinklers
Generator
1:1
Roof = Roof pitch
Total Sq. Ft of Constructions l
Cost of Construction: $ N00Q• �Q
5 Ft. of First Floor: _
Utilities:cn Sewer El Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name f5�1 016I2q��
Name:1,'' pp
Company: (p_ A%'r R hyin-tLW
Address: 401 ��Sh / sVQ�
City:-M.1YI/ILO gt&cil State: k'
Zip Cod '5SO(n0( Falx: ua
Phone No. : 413 4215-3$ olvii5
Address: BIOS A-Ti.txnyi ICL
City: dz:�RQ(C,2 State:
Zip Code: 3 k Fax:-�17?--4&(a -237
PhoneNo. 770.-4(o
22j
E -Mail: I��A• IsJzaA:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E -Mail:
(tsNYl
_
State or Cou ty License: (i{�l' (ti I$l� (t
If value of construction is $2500 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:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
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 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
:ommencinE work or
Signature of Owner/ Lessee Contractor 4 Agent Q Owner
Signatureof�r/� Contractor/License
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF %. l uia L COUNTY OF
The fing instrument was acknowledged before me
this 14r
day of Afd ( , 20(by
Mi((ita 'U —
Name
of person rng statement
Personally Known OR Produced Identification
Type of Identification
Produced
of
CHRISTINE J. Coi"WELL
-NOM ry-Pablie State
Commission # GG 017839
My Comm. Expires Aug 21, 202
Bonded t4dagh Nationa
S� =lizl r✓
The for ding instrument was acknowledged before me
this f7dayof)�Tyikrlk 20A by
U(Ckuw C_ FA e_1'
Name of perso akirig statement
Personally Known OR Produced Identification
Type of Identification
Produced
NS
VG SUPERVISOR
ICOUNTERREREVIEWREVIEW
COMPLETED
Rev. 8/2/17
of Notary PubpCjState of
CHRISTINE J. COMT96�bl)
Notary Pubhi State 1 Florlda
Commission # GG 017839
REVIEW I REVIEW