HomeMy WebLinkAboutBuilding Permit1LL APPLICABLE INFOMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: i nJI -ifiq Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 ,V/J
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: M5eyi " nD � M Nrce , _Mclus
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Legal Description: I 1Aq _Pyri !s
Property Tax ID#: 2303- Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
In
iti a workto e e orme under this permit- c hecka apply:
HV/1C � Gas Tank ❑Gas Piping _ Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction::
Cost of Construction: $ A000, 00
S Ft. of First Floor: _
Utilities:cn Sewer 0 Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name LtSi1i Vu
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Name:
Address: !)`
Company:Fmylg, Ric
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City: Pt) 6$CA/VMO 13C. AO State: 0-
Zip Code: 1 � OtOCJ Fax:
Phone No.
Address:510 fiJ�[
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City: fb(-b—17ie(C&
Zip Code: '3"5 1
Phone No).�rta_ LN
State: R_
Fax: -71-7-- 41pr 373-7
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail:6)stten`[ P_ ga
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State or County License:
CAC 1818I $
if value of construction is $2S00 or more, a RECORDED Notice of Commencement is required.
OWNER/ CrOR AFFIDVtT: 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 County makes no representation that is granting a permit will authorize the permit hoiderto build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and that
covenants 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, swimodog pool% 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
commencingwork or recordingyour Notice of Commencement.
Rev. B/2/17
supPCEn�€Nr�l_ cczt+�tuerlal� f.�€�l Lam ��r-af�nna-no�v:
DESIGN€R/ENGENEER:
Name:
_Not Applicable
AAORT�ARaE COMPANY-
Name:
_ Not Appiir�bie
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE NQLDFli:
Name:
Not Applicable
BANDING COMPANY:
Name:
_Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone;
Signature o, Owner txssee/ ntractor s Agent for woes
Signature of Cantrauor(license Holder
STATE (3F FLORIDA •
STATE OF FLORIDA �i C
STATE
CQlDNTYt3F -'1 [�U.l,tl�J
COUNTY OF
The forgoing instrument s acknowledged beforlop e me
this Ldayai_1��20� by
The forgoing instrume t w_ as acknowledged before me
this ,jj_dayofQL�{l �Y .20a MI
` Niticbtuet F. goy [ems
i cU ¢[ F � �
Name of person king tement
Name of persa along slat mint
Personally Known �OR Produced Identification
Personally Known OR Produced €derifificatiort
Type of