HomeMy WebLinkAboutBuilding PermitALL APPLICABLE INFO
MUST BE COMPLETED FOR APPLICAI ON TO BE ACCEPTED
Date: 3 ow Permit Number:
Building Permit Application
Planning and Development5ervices
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-157$ Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
.`PROPOSED IMPROVEMENT LOCATION:
Address: DoLloC
Legal Description:
0
Property Tax ID #: 3430. 5oa -000 4 - 000 - (e Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK -
L110 0� U0., SyLS-tall new 3.5-Ibn , tiv ScpK Gev�nQx SF }kC
51st 4yl WIVI, l0 KtJ head
CONSTRUCTION INFORMATION:
Addivirnal work to(e performed
orme under this permit- check a appy:
HVAC LJ Gas Tank [_]Gas Piping Shutters F]Windows/Doors
Electric 0 Plumbing OSprinklers 0 Generator 0 Roof
Total Sq. Ft of Construction:
Cost of Construction:$ 5400.00
SQ. Ft. of First Floor: _
Utilities: LJ Sewer 0 Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
I
Name:
Address: 3a,la IVIr. Dr.
Company: i (
i £Hpaflq TA
City:fmk R(.rCQ. State:
Zip Code: 3gg_� I Fax:
Phone No.17a - al l -2(03-1
Address: 5(0 6 PrTU,rn ikQ_ I
City: fb(-b- Rtrc?i
Zip Code: S"5` 1
PhoneNo.-r19- ^tt0(
_&L,
State:
Fax: 7?a Lt(prp-3%3`f
-�t1+1
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the owner listed above)
E -Mail:
_
State or County Licen e:
C A4,- 181 S 18
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNERANGINEER: _ 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:
City:
City:
Zip: Phone:
Zip: Phone_
EMNERJ CUINTRACTOR AFFIDVff: 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.
0
�ennit holder to build the subject structure
covenants that may, restrict or prohibit such
it any restrictions which may apply.
In consideration of the granting of this requested permit, l 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
mendme nts-
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 work or recordinfa vour Notice of rnmmpnrpmpnt.
Rev -8/2(17
Signature of Owner/ Lessee/Contractor Agent for wner
Signature of Contractur/license H61der
STATE OF FLORIDASTATE
+
OF FLORIDA '..J•n
COUNTY OF el t'
COUNTY OF LUWL
The forming 1"rpent was acknowledged before me
The forgoing instrument was acknowledged before me
this day of Yll9nWt4, . 2010 by
this day of. Fj bgML T . 20 ?.o by
Wchael F. Boyle.
micw e le,
Name of person aking stAtement
Name of perso along slat went
Personally Known OR Produced identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
�J��
(signature of Notary P is -State of Florida),
(Signature of Notary o- State of Florida )
Commis nQ riiRisfiuE J. COIiW€t3j,�
T ,a.'%
Comm tory a, c r CONWEL
°o"
i o: Notary Public -State of Floritla
, aiRr ^ya,—�...,.�.,Nz-..
;?° L% Notary Public - State of Florida
' : •e Commission # GG 017839
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° . •' Commission # GG 017839 '
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i I ssn ANGROVE
COUNTER
EViEW
REVI R
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DATE
RECEIVED
DATE
COMPLETED
Rev -8/2(17