HomeMy WebLinkAboutBuilding Permit ApplicationPlanning and Development Services
Building and Code Regulation Division /
2300 VirginiaAvenc;4 Fort Pierce FL 34W
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from drophox, click arrow at the end of line
PROPOSED IMPROWMENT LOCATION:
arlrlrP«- 6Z00 Gt1i5h IVP,fM Waci, 45i
Legal Description:
PropertyTax lD#: I31�.-503 -000(n -000 =
Site Plan Name:
Proiect Name:
Lot No.
Block No.
Setbacks Front Back Right Side: Left Side:
➢ETAIL£D I] CRIPTION €3FWORK:
Li IQ �D( Uo-: I hew Wrwx 5}on, sv t*
( 'I* 10 U) _B64G-Up W,* .
LIHVAC L Gas Tank
Ll Electric 0 Plumbing
Total Sq. Ft of Construction:
Cost of Constreiction: $ 6 500.00
Piping LUShutLers IlWindows%Doors
nklers _ Generator Lel Root Roof pitch
Sq. Ft. of First] �Floor-,
iftil- setter # _#Septic Building Height
OV1sER%LESSEE:
CONTRACTOR:
Name
Name:_M�{,kCto � 3
L✓
¢�"
Address: 51 OD �Vltl llS� 1 �11VQ (
Company: & Y
_
_
(iffllaaz
City: � V1Q, (& l (r'L 34 015 t State: _
Zip Code: Fax:
Phone No: -1 a - 321 - 3 494
Address: Sio-Tkrn FILe
W -
City: OfM a(
Zip Code: 311a 6 1
Phone No. j 2'- Lt(e 1-
stater
Fax: -7Z) --46G-3137
141
E -Mail:
Fill in fee simple ride Holder on next page ( if different
from the owner listed above)
E -Mail: )C 1J LC Q VZkCJO • COYY\
State or CounTty License: CAC0 313(p
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORik AlioN:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name: —
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HoLoE[2 _ Not Applicable
Name:
BONDING COMPANS'; _Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNEtij € AFFIOVIT: Application is hereby madeto obtain a permit to do the work and installation as indicated_
I certify thatno work or installation has commenced prior to the issuance of a permit
SL Lucie Cz immakes no representation at is granting a pewit wiff authorize the permit holderto build the subject structure
which is in ithat
ct 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 pians, The Florkla Ding Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review_ room additions,
accessory structures, swimmirsg pools, fences, watts, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER. Yawfadure to Record a Nice € f COnagiriencement May result In yew 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
commencing work or recordine vour Notice of 3'nmmw rampnt
�e �7
Sv nature of Owner�Lesse oniractar int Owner
nt
Signature of Contract rJLicense Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF ✓1. 1 UCJQ
COUNTYOF LA
The forgoing instrumept was acknowledged before me
The forgoing insutymentmas acknowledged before me
this5_L`dayof I 2fl-aby
this �day of PKi 26_Jby
Wcutl f $Dyle
Mickgf Fr $oyl�
Name of person making statilment
Personally Known OR
Name of personpakirrg statement
✓ Produced Identification
Personally Known V OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
NE'J. CONWELL
W
(Signature o "'; blic-Sfftli9FilxtdbWELL
t..... rid
(Signature of Nota ea G017839
Notary Public •State of Florida
Commissio !�' •- Commission x G[S9�Yv939
.-.l
Commission No_ ;F P my Comm. xpire Aug 21, 2020
%;,,t o„• y omm. Expires Aug 21, p2o
��°_Bonded throe d al Notary Assn.
_
"°u��° Bonded through National Nolary%ssn.
d
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Rev. 8/2117