HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 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: :�$ I�
Ft- 34951
t/�
t , 1`' ! Fv `�(!
Legal Description: 5(DMISO (,E U-S �lrt�t 1.�1. b
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back:. Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
b 6/; J asiu,(( '+ -Von tit Seem FrirJoLjra, ?0'r-k-a t u.nif
wig to Kw haat:
CONSTRUCTION INFORMATION:
�ti a wor to e e orme under this permit -check a appy:
HVAC Gas Tank 013as Piping_ Shutters Q Windows/Doors
Electric ElPlumbing Sprinklers O Generator E]Roof
Total Sq. Ft of Construction: S Ft. of First Floor.
Cost of Construction: $ M00-00 Utilities, Sewer E]Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name
Ktt4
Name: WchLld
Address: 45? (,.avil" Wat'
� h "�" " � T& "
Company:97)Yk Air (Ndih����b1,/A'�£�_�1r1�.
City: 1f71(i- ipier,t, Stater
Address: 5106` A_ ,(VIOfko_ fi. P)d
City:t'O(b-PPief"C& Stater
Zip Code: 3"S1 Fax:
Phone
Zip Code: S4q 5 1 Fax: 1?.2-- g&O-3731
E-Mail:
Phone No.-"ol- ^s'tpt-414'1
Fill in fee simple Title Holder on next page ( if different
E-Mail:
State or County Licen e: CA I$ IS I
from the Owner listed above)
If value of construction is $2510 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
ITESIGNER/ENGINEER: —Not Applicable
Name:
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.
Crty:
Ciiy:
Zip: Phone:
Zip: Phone:
OWNEW WNTRA£ iOR AFFIDVfr: 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 t
which is it
structure_
the permit holder to build the subject structure
r andpcovenants that may restrict or prohibit such
led 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 moms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying Mice for
improvements to your property_ A Notice of Commencement must be recorded and posted on the jobsitee
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording vour Notice of Commenct-mant_
Rev. 8/2/17
Signature of owner/ i-esseej ntractor Agentfor caner
5igreature of Contractor/Licewfe Holder
STATE OF FLORIDA1 _t
COUNTY OF
STATE
UOfORIDA
S Lub,&
NTYo
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this Ukk day of mal t frt�o2( 20jq- by
:t
this day of �,Yri%Ef 20 I4 by
PkOet F. Boy Ir,
,
[4j i w F• &A,
Name of person aking stitement
Name of perso Acing stat mens
Personally Known OR Produced identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
{Signa e
(Signature c- State
irar nye, f{R INE7CONWELL
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Comm siryq' �°G°. CHRISTINE I. CONW '
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- Notary Public -State of F�r
Comm
Notary Public -State of Florida
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• • = Commission # GG 017839
_- # GG 017�39�1
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UPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVI
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17