HomeMy WebLinkAboutBuilding PermitALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
KO �- --
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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: q lc> t
�rt�c t k
Legal Description: IkJ'u.- �+�`^�r � A�5 -U",+ aq- _ L-+ $
Property Tax ID #: �J`�flZ' � ' biZL l 6C�0- 1 Lot No.
Site Plan Name: i mil- G'L Block No.
Project dame: '
Setbacks Front 'f" Back: 4 Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
1.n54-4t( 6r 6w.ts.e ypx5�-
}�s _1x' d�' �c P�ti��«� � �t I I.iZ564�
CONSTRUCTION INFORMATION:
Additional work to e e orrne un er permit - t is pchecka apply:
�HVAC E] ❑Gas Shutters Q Windows/Doors
Gas Tank Piping _
Electric ❑ Plumbing Sprinklers Generator 0 Roof C] Roof pitch
Total Sq. Ft of Construction: Scl. Ft. of First Floor:
11
Cost of Construction: $ 0,560.00 Utilities Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name V.4141
Name:- ce
Address: lot ac�a�c.
Company: ?'4e 6&'5 f-rr`C'
City: !✓ P� c r cz State: fL.
Zip Code: 3 4 q bZ- Fax:
Phone No.
Address: ZCa°
oK ��'� �`'`�
City: 05L _
Zip Code: 3�1q53
Phone No. In 6 711.21-17.3
State: (rC-
Fax:Z'�7g'fo `' g
0
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: CiAe, c
'rMa"► as
State or County License: e •d S r
if value of construction is $2500 or more, a RECORDED Notice oT Lommencement is requireu.
I SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: I
NER/ENGINEER: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Zip: Phone:
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 contlict 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 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
commencinje work or recording your Notice of Commencement.
re of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF i>J L c-' C -
The forgoing instrumeQ was acknowledged 4efore me
this X3_ day of 20 j_by
J,
[Name of person acknowledging
C V _
(Signature of Notary Public- Stat''of Florida )
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF L., --I L.
The forgoing instrumen was acknowledged before me
this day of 20 by
kLa 02 a
(Name of person acknowledging)
{Signature of Notary Public -State of Florida )
Personally Known � OR Produced,kotltiikg"��
tyl
Personally Known OR Produc e P+ I T .yr__.._..._
Type of Identification Produced \0 I >/r
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Type of identification Produced �` 4� • • Z
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Commission No.l�� } rz,
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