HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: O Permit Number:
Mom, ouncling rermn Hpp icavon
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
PEKMI I APPLICA I ION FOR: To Select from dropbox, click arrow at the end of line 1
PROPOSED IMPROVEMEN I LOCA I ION:
Address: 328 /q :L a I2 d 1 / 10, (21-
Legal Description:
Property Tax ID #: 3 VoI5 _ 703 — Of 82 — 000 " Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DE I AILED UESC:KIP I ION OF WORK:
CONSTRUCTION INFORMATION:
Aifd9ta wor o o�e a orme under this permit -check aiT app y:
AC GasTank []Gas Piping _Shutters FWindows/Doors
Electric F� Plumbing Sprinklers 11 Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Ya0 Utilities F]Sewer _ Septic Building Height:
OWNERAESSEE: CONTRACTOR:
_ _
Name/!!!I►�C L�C. der
Name: GUCLT('� 'SAaky\crnS fl
i Company: t`L(r,7'am A u S ems (lu c
ill
Address: 37Za t��-F I(�a e
City: State: �L
Address: 147(5 6 E Ut II etQ-,c reei1 Q
Zip Code: C3 (495a Fax:
City: ((- fir S� f- uci e_ State: r-_-
Phone No. 6Q3I -�>,a7- (o5(e
Zip Code: �L+g52-- Fax: 717W- j 35-i cf 6� r �
E-Mail:
Phone No. T11 3 3S- 3 2 3 i
E-Mail: C u S t & t r 5 ti s ac o [ . C t, o'L
RII 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.
i
SUPPLEM EN I AL GUNS I RUC I ION r iEN LAW 1 Ni UlitVlA t tCj I`d:
DESiGNER%ENGINEER: ___Not Appli: ab{e
MORTGAGE COMPANY: Not Applicable
Name:
_
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone:
i Zip: Phone:
i
FEE SIMPLE TITLE HOLDER: — Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address: '
City:
City: i
Zip: Phone:
up: Phone:
I certify tiiat no �rork or installation ias commenced prior to the issuance of a permit_
St- Lucie Courhi makes no representation that is granting a permit ,_ilt authorize the permit holder to build the subject structure
�-.hich is in conflict mvith any applicable Home Owners Assocration rules, b,_ la-,, s orano covenants that may restrict or such
prohibit
structure- Please consult,v� h your Home Owners Association and revie,V your deed for any restrictions which may apply -
In consideration of the go ranting of this requested permit, I do hereby agree that t rill, in all respects, perform the v.ork
in accordance t.ith the approved plans, the Florida Building Codes and St_ Lude County Amendments.
The follo Ang building permit zpplications are ekeirptfrom undergoing a full concurency revie.v: room additions,
accessory structures, sMmming pools, fences, :ga ls, signs, screen rooms and accessory uses to another non-residential use
WARN iNG 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. It you intend to obtain financing, consu It with lender or an attorney before
commencing work or recording vour Notice of Commencement.
Signature of O>-,,:ier/�-essee'Contrat_ior as Kgentfor Oa:,ner
Signature of Contractor/License Holder }
STATE OF FLORIDA !
STATE OF FLORIDA 1
COUNTY OF
COUNTY OF
I
i
The for ing rostrum�rt�s=,as ack� s.�ledged before me l
this / day f-1 U ti_u /
n g i e
g nsfn=meat �4as ackno,:tedoed before me
The �Xay
of 20 b�- (
this of Uq,4,j- - 20 by
i
(Name of person acknc,, ledging)
(Name of person acknov lodging )
(Signature of Notary Public- State af F eriria) {{(
(Signature of Notary Public- State o:` Ica 7
Personally Kno,vn OR Produced Identification
Personally Kno*min OR Produced Identification
Type of Identacmtien Produced
Tape of Identification Produced
Commission No- Y° CtfRISTiNEBENYpUv�c
=9 `Sas," iWAifimissionNo.
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