HomeMy WebLinkAboutBuilding PermitALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:—(Q_128 114 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: 33 ,�}
IA,C'� c II f . e. gY�U(pL piP f fP 3 qq S
Legal Description: _C>Edyll sh CA k�S U ✓(i ru\ P.G r b
Property Tax ID #:
Site Plan Name:
Project Name: _
Setbacks Front
Back: Right Side: Left Side:
Lot No.
Block No.
AILED DESCRIPTION OF WORK:
sib I Lenhox 3.S -bn i sE 2
5` Vif- A [C- si�s+-em w if -h to W) kms.
STRUCTION INFORMATION:`
Prhal work to b rme under tispermrt-c ec a appy:
HVAC Gas Tank []Gas Piping _ Shutters Windows/Doors
Electric Plumbing nSprinklers Generator O Root
Total Sq. Ft of Construction:
p
Cost of Construction: $ goo . oo
5ar of First Floor: _
Utilities:Sewer Septic
Building Height:
OWNERAESSEE:
CONTRACTOR:
Name
Name: Y{'+
Address felt
Company: (
61 �.
city: )0- ( 2rce- Stater
Zip Code: M51Fax:
Phone No.122 - M - l '-3$U
Addresss:510 Pr -U-MOLL
City: h)( -b-
Zip Code: S 0 `5d 1
Phone No. -"A- -Yaf
State: rL
Fax: -77;-- 4&0--_373-7
-414't
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail:6wl Oft
�QQ, on ro
State or County Licen e:
CA -0,1$181$
R value of construction is $Z500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTALCONSTRUMON LIEN LAW I FORMAMN:
DESIGNER/ENGINEER: _- Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State: _.
Zip: Phone -
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER. Not Applicable
Name:
BONDMIS COMPANY: _Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip Phone:
OWNER/ CONTRACTOR AFFIDWr: Application is hereby made to obtain a permit to do the work and installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit
subject structure
rict or prohibit such
may apply_
in consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
In accordance with the approved plans, the Florida Wilding Codes and St Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory use$ to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in yaw 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 financinF_ consult with lender or an attomev before
Signature of Owner/ lessee/ContractorAgent for caner
STATE OF FLORIDA U&
COUNTYOF v`
The forgoing instrument was acknowledged before me
thisl$� day of 0(,f0bff 20 19 by
Piti howA 'F &3 jlz�
Name of person aking stiternent
Personally Known OR Produced Identification
Type of identification
Produced
(Signature
Commission No. C yRl TINE J. CONWELL
Notary l State of Florida
•= Commission # GG 017839
^„• ,F My Comm. Expires Aug 21, 2021
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new of Gf S:
Signature of Contractor/license Holder
STATE OF FLORIDA <3�f - , ,
COUNTY OF_ Ll tt�
The forgoing instrumentw3� acknowledged before me
this ALL day of �blLf 20L_by
Name of persopTriaking statement
Personally ttnown off OR Produced Identification
Type of Identification
Produced
C"
,nV n'v CHRISTINE J. CONWELL
B
Cnrrimi55ior o:':o r Notary
com Public - St R39
• orida
Commission # G 01 39
�7_ My Comm. Expires Aug 21, 202
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