HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLlCLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: { "'lt9 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 III
PROPOSED IMPROVEMENT LOCATION:
Address: /W,
Legal Description:
�M�
won
Property Tax ID #:1, ppl _ 01 -ol 44 - 00073 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Ll1 4, -For U d: -�n Wl 3 iorl 14 , 5 SEEK tf0na� �[t
SVG4 St 5+trn WM to 0 hecu.
I CONSTRUCTION INFORMATION: III
L"1HVAC L Gas Tank
❑Gas
Piping
❑_Shutters
❑Windows/Doors
11 Electric
Plumbing
Sprinklers
1:1Generator
11
Roof
Total Sq. Ft of Construction: ,\
Cost of Construction: $ 44 D0. OV
5 Ft. of First Floor: _
Utilities-, SewerDSeptic
Building Height:
OW NERAESSEE:
CONTRACTOR:
Name 0614-t
i150d1
Name: %iiC�M F B0'/1P�,
n6_._
Addrerrss:-100� QQpfG(q
CompanyYl�ltil lit
City: t'l/('� V1er(f_ _State
Zip Code: 34g5( Fax: N A
Phone No. -la- $mot--Q.55(o
Address: 5105 A TIAfnI Lo E?, U=
City: rb P14f11?, State:1;7c
Zip Code: 34aS I Fax: -711 44 1a, 9737
Phone No. T?).'�¢I-4141
_ —_
E-Mail: r JA
Fill in fee simple Title Holder on next page I if different
from the Owner listed above)
E-Mail: J Qflew 0 IJAW O. m
State or C u0 my License: 18I'81$ b
If value of construction is $2S00 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUC110N LIEN LAW INFORMATION-
dim
Address:
City: State:
Zip: Phone
MORTGAGE COMPANY: _ Not Applicable
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _blot Applicable BONDINfa COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER] C.ONT HAC OR AFFIUVIg. Application is hereby made to obtain a permit to do the work and insiatiation as indicated,
i certify that no work or installation has commenced prior to the issuance of a permit.
the p�rm�� holder to build the subject structure
r and covenants that may restrict or prohibit such
,ed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I wilt, 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 swimmunig 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 resent in your paying twice for
improvements to your properly. 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
VIWI sslafa``+[flcatlYl=#TL�IiS`iliiS#IiZ3
Signature of Owner/ tractor Rgent ner
Signature of Contractor/License Holder
STATE OF FLORIDA I STATE OF FLORIDA
COLINiYOF I COUNTY OF
The forgoing instrument was acknowledged before me
this jL4,dayo£ LAaAA, .29-1-Ot- by
M►'c of
Name of person king statem nt
Personally Known OR Produced Identification
Type of Identification
(Signature of Not&II Public- State of Florida )
Commission No. ,•`aa+>�%„ CHRIS(Siiijg. CONWELL
r �? otary Pub!iC State of Florida
. : Commission N`GG 017839
`� "1%�4W1 Bonded
REVIEWS
COUNTER l REVIEW l REVIEW
DATE
COMPLETED
9 ra 117
The forgoing instrument was acknowledged before me
this 3llyday of 20-ft by
( r D Q�
Name of person pi&ng Aatement
Personally Knaxn V OR Produced Identification
Type of Identification
(Signature of Notary
REVIEW