HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST 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_
I PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT- LOCATION:
Address: 4 2-00 i�_ . 111 YA i fi 12-H
Legal Description: u sic uy k b I C a 3 u 1 Z (`{ b u N o
T I~ T 11 O IDr 6 MEN r
Property Tax ID #: 142- ) o i� t7 ®" - Lot No.
Site Plan Name: Block No.
4 Project Name: % 3 aim Z-
Setbacks Front Back: Right Side: Left Side:
DETAILED- DESCRIPTION -OFWORK: i
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Sy5 i-fa-, wI
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�VCCJ-0- $
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-CONSTRUCTIO11t WFORMATfON:
Adaitional work to be nerformea uncler this permit -check
HVAC Gas Tank []Gas Piping
all t= apply:
l
Q
Shutters
Windows/Doors
CElectric Plumbing
Sprinklers
0 Generator
Roof Roof pitch
Total Sq. Ft of Construction:
S Ft, of First Floor:
,r �c
Cost of Construction: $ `t �-z{�
Utilities: Sewer Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name �i CG20 4 i�14?CLv1dZr -tcw r
Address: y.2 N A i W lAn: l 2l
Name:t>en)44A -fat
Company: &L-lu Air Ccnd►•ktia-:v,G A- I -
Address: 3 t ,,t c or r. % S
City: 1 5 State:
Zip Code: 3 I y _ Fax:
Phone No. U 2-I Ci L I (P
City: P SL State: tL.
Zip Code: '� CA Fax:
Phone No. 074 QA-li - U-15
E-Mail: (A V-Cff&Lp19 CC (fXz.,,ty �5 �D Cc of . (_tan.,
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
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State or County License: CAA $1-1 9 9 6
sr value ar consirucsion is >isuu or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
GINEER: & Not Applicable
Name: '
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
Not Applicable
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 conflict 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
commencing wW or recordir1gyouX Notice of Commencement.
s
Signature of Owner/Lessee/Con ractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF _ �. L, C-C COUNTY OF _5 Ly L e
The forgoing instrument was acknowledged before me
this` tiday of i6 201-by
i GLw
(Name of person acknowledging)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification Producedb(' Wr'S Ll r lr, �,e
Commission No,r7. I) KAREN O. CHISH
# MY COMMISSION #F
EXPIRES: MAY 18,
Revised 07/15/2014
The forgoing instrument was acknowledged before me
this day of _LJj &, b 20 a by
S �Z
(Name of person acknowledging )
K C'_x 0 L_
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identificati Pr duced
nNo. FF99i3$la IAOR KAREN0.CH
MY COMMISSION
Banded through 1st State
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