HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
-
oulliaing rerm;lt Hppucavon
Punning and Development Services
Building and Code .Regulation. Division,
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-2553 Fax: (772) 462-_578 Commercial Residential
PEKMI I APPLICA I IUN FUR: To Select from dropbox, click arrow at the end of line
PRUPOSEU IMPROVEMENI LOC;AIION:
Address:
Legal Description,:
Property Tax ID is �yi� 'tQ/- D�/7� 000 -I Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DE I AILED UESCKIP I ION OF WORK:
`� �� iYsfer CASMs< o v 1°��✓
G /ate,
[CONSTRUCTION INFORMATION:
Additiona vJorTc to be berformed under this permit— cFeck a-fr apply: — - -
�VAC Q
Gas Tank ❑Gas Piping L—I Shutters Windows/Doors
Electric aPlumbing �Sprink{ers Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Fit. of First Floor:
Cost of Construction: $ f �n c> D Utilities: 11 Sewer OSeptic Building Height:
OWNER/LESSEE: 'CONTRACTOR:
Names QJ/Q lha �p Name: C.(,iCTI ShirLl�y1C(IS
Address: L�Ola //1lt1/�i �l�nT�l�1C L� Coco pang: Cct 5-F6 at A ems ( ti r-
City: PGid i oiT (ice c t Stater 'Address: 16-1$ S E \/I I ( tic, _e f ee r�D l
Zip Code: 3� Sa- Fax: City: Pc' l`i 9t . L u c t t-- J State:
Phone No. �ZlS' C�'�.Z -,6"'I'70 Zip Code: ' K 95z - Fax '77,?- J 3 65-i 9 1
E-Mail: Phone No. 33S - 313 9-
Fill in fee simple Title Holder on next page { if different E-Mail: L� St C1 i r- S ti s p cc o l c c-vrk-
from the Owner listed above) State or County License: R C C? 5 { ( C)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMEN IALCONSI RUC I[ON -'LIEN LAVA INFURMAIION:
DESIGNER/ENGlNEER: _Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
_
Name:
Address:
i Address:
City: State:
City: State:
Zip: Phone:
i Zip: Phone:
FEE SIMPLE TITLE HOLDER: — Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address: 3
C ity :
City:
Zip: Phone:
Zap: Phone:
j
i
I certify that no work or installation has commenced prior to the issuance of a permit_
St- Lucie County ;Hakes no representation that is ;ranting a permit 4.ill authorize the permit holder to build the subject structure
which is in conflict with any applicable Fiome Owners Assocration rules, btaay.1s or and covenants that may restrict or prohibit such
structure_ Please consult viith your Horne Owners Association and revie_y your deed for any restrictions >•jhich may apply_
In consideration of the granting of this requested permit, I do hereby agree that 1 will, in all respects, perform the cork
in accordance vAth the approved plans, the Florida Building Codes and St_ Lude County Amendments -
The follaring building permit applications are exemptfrom Undergoing a full concurrency review: room additions,
accessory structures, sLvimrning pools, fences, .va=1s, signs, screen rooms and accessory uses to another nor -residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to your properfij. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection. if you intend to obtain financing, consult wraith lender or an attorney before
commencing work or recording your Notice of Commencement.
i
_ s
Signature of Ovl:ier/�essee,'ContraCLor as Agentfor owner j
Sio ature of Contrac:orfLicense Holder
STATE OF FLORIDA I
STATE OF FLORIDA
COUNTY OF ~` !
COUNTY OF
I
The forgoing instrument �.-jas acknowledged before me j
The forgoing instrument was acknowledged before me
this day of To/ y 20 /9by j
i
this 15 day of (.T, 20 by
(Name of person ackr;c: pledging)
(Name of person acknot:ledging )
(Signature of Notary Public- State of Ficrir-ia) I
(Signature of Notary Public- State of ..-109
Personally Knoi-vn OR Produced Identification f
Personally Known OR Produced Identification
Type of Identification Produced
Type of Identification Produced
1
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Commission No_ �r - - ��..��uuttp(� CHRISTINEBIN(Wlfimission
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EXPIRES: AP14,2021
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