HomeMy WebLinkAboutBuilding Permit Application111 APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1 Q ,,nn ����jj��
Date: It30 "f9 Permit Number: ` `�yU'''`�
Building Permit Application'
Planning and'DevelopmentServices
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:�,,�o�-�[;on
PROPOSED IN'P'ROVEMENT LOCATI N:
Address: 2 y%' A/Y 7YI0d 88I0 .Telfd-eti 13&e.C. A Of ?Ycl5' 7
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Legal Description: ,/1/G�/+�.! �L d�an� 7' C �33 58-22 30)
Property Tax ID#: V6'02--50/--0y33-00075"
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Site Plan Name: /yC #%4S
Project Name:, y7
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Setbacks Fkont Back: Right Side: Left Sided
40
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Lot No. .211/7
Block No.
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Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric _ Plumbing _ Sprinklers Generator _ Roof Pitch
Total Sq. Ft of Construction: 3,?11 Sq. Ft. of First Floor: 3 91/ Cost of Construction: $ /900.oa Utilities: Sewer _Septic Building Height: 8r�
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OINNERjLE=�S`�S � .
CONTRA OR. ,
,' Name '.iri ;r,,D =J h fi` ..: oI eWe�
Address: ? O`r�'i4lahcf v�l'•
Company'7L/i UrO��af Sl/�. i�G,.
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City: //[rir7»A�Y`i2, "i, " State�4e
Address: ��/ `�Y.E;..SIJt.�ce� `'57
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Zi p Code: Fax:
JI
ea'ev State: �'L .
Phone No. qD/�- Z�Z ' S -70
Zip Code: 3 9f "" .`=Faxs7:772' 232
Phone No 772' 2S0 - 3 7/6"
E-Mail:
E-Mail Q u m i ^c 6V ►/aJ44.6ei'm
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
OPPLEMy, ENTAL CONSTR CTI N' I4N.
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
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 pt-ohibit 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 Twill, 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
commencing work orxecordinia vour- Notice of Commencement. —
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Sign, t eAof Owner/ Lessee/Contractor as Agent for Owner
-Signature of. Contractor/License Holder °..
STATE OF FLORIDA
STATE OF FLORg
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instru ent was acknowledged before.me
this day of 20L A by
th's _day of 20 by
(Name of person acknowledging)
(Name of person acknowledging)
( gna ure of Notary Public -State of Florida)
(Signature of Notary Pub ,- State of Florida
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced l*
Commission -No. MI G
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DATE
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Rev. //ZU14