HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �� 5_ 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: 16103 Q IYI00 If• , 56 1f cb 3Lf41SI
Legal Description: [f/�L(tw)� iParV. - (I'Ali- 3 - 5((G 2Z , LofS Zs s. 2(e
Property Tax ID#:130 'lCib3'D"[-O00=-7 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back:
Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Uki for U �e, , fiqsia[L new ItnnoX ( -seer 2.5 -fOf 1 5�11t A(C 5gsftv4
�v1 7.5 Kw h&ct
CON
UCT10N INFORMATION:
iti na workto e e orme un ert �spermit-c ec a app
_ HVAC Gas Tank11 ❑Gas Piping _Shutters ❑ WindowsJDoors
Electric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: OO rMn
Cost of Construction: $ 3 0�� • w
Sq. Ft. of First Floor:
Utilfties:SewerE]Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name.UUJ0r&
Name:
��(
Address: jQ03 viF511n10✓1{'
r.
Company:50g1P- Nir CQAturillaz
City:�b(-f (rce, State: FT/
Zip Code:,105 I Fax:
Phone No.7Q$-- �O3 �D d
Addre s: 510 A g -
City: �` State: Rl
Zip Cod'�- e: W Fax:�)•- 4(-3137
Phone N11o�..%70A- 1.F(p I -%i (1+ 1
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail:170
S/1ka2I.
00 •(WW1
State or Co uLicense: CAk ,181 S I $ (P
o vame or construction is >&,uu or more, a KtcoKDED Notice of Commencement is required.
SUPPI EMENTAL CONSTRUMON LIEN LAW 114FORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Flame:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY. _Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIF: Application is hereby made to obtain a permit to do the work and instaiiat'son as indicated.
I certify that no work or' Installation has commenced prior to the issuance of a permit.
St- Lucie C
which is it
structure.
ermit holder to build the subject structure
covenants that may restrict or prohibit such
tr any restrictions which may apply -
in consideration of the granting of this requested permit, I do hereby agree that I will, in all inspects, 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 concurs ency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessoryuses 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 or recording ur Notice of Commencement.
Signature of Owner/ Lie ntractor Agent r Owner
Signature of Contractar/License 11older
STATE OF FLORIDA L
T Lk(e
STATE OF FLORIDA f'.A
L tC le
COUNTY OF ,
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this— day of wt 2011 by
this ',14� day of �Tfj ) , 20_ft by
Name of person ing st tement
Name of person dng statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
• n t;G✓�
� �-O�Gv-0���
(Signature f N ...... I btic C0€k1PMR6NIrELL
(Sign State of Florida)
`4? Notary Public - State of Florida
,
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Commissro '. Commission # G[SUIP39
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CAm __-T'. U*c3 �i�i at Florida
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Bonded through National Notar}rAssn.
i e
ational Notary Assn.
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Rev- 8/2117