HomeMy WebLinkAboutBuilding PermitALL APPLICABLEINFOMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: r'Ur Permit Number:
� o b .k •
WillBuilding 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: _{g.);k
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Side: Left Side:
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK:
Ukc 4:or U fq• SrfsWt htw 1+-Non il- 5EEk f?ub A & PaelcacL imi
W'* l01<0Iaeat%
CONSTRUCTION INFORMATION:'
AdIdmittipal work to be nej orme under this permit -check a apply:
HVAC { _1 Gas Tank Gas Piping In Shutters Windows/Doors
_
11
Electric Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction�VUU.
:1,�f�
Cost of Construction: $ 'I 80
S Ft. of First Floor: _
Utilities:,nSewer Septic
Building Height:
OWNERAESSEE:
CONTRACTOR:
Name
LUnaebVirits
Name: {'
Addresse/s: Sflj5ln (Alas N�
Company: ( 1 c ti
tale.
City: 4!0(t State:rL
Zip Code: 1 Fax:
Phone No. `i?2 5;3 3
Addresss�:3ld "�t Am�ks. P �iC� • r
City: YUtrb— f7f eic& State: r,(-
Zip Code: 134i 51 Fax: 4&1P-373i
PhoneNo.-rig- 4YOt-414-1
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: CkC l $ I S I
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUICTIilN LIEN LAW INFORMATION:
DESIGNER/ENGINEER- —Not Applicable MORTGAGE COMPANY. _,Not Applicable
Address: I Address:
City: State: I City: State:
Zip: Phone I Zip: Phone:
FEE SIMPLE TITLE HOLDER- Not Applicable
Aacress: I Address:
City: City:
Zip: Phone: Zip: Phone:
UWNEIi/ GDN € MLYOR AE€ii3YET: Application is hereby made to obtain a permit to do the work and installation as indicated.
1 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 pemut 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 wefh 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 inspects, 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, wails, signs, screen rooms and accessory uses to another non-residential use
WARNING TO OWNER- Your tenure 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 recordine your Notice of Commencement -
Signature of Owner/ Lessee/Contractor Agent for ner
Signature of Contractor/License Holler
STATE OF FLORIDA
COUNTYOF Ukeie'
Si'ATE OF FLORIDA
JT
Jf_
COUNTYOF
The forgoing instru ent was acknowledged before me
The forgoing instru nt was acknowledged before me
this AG&Nay ir"r( 20 20 by
this RJP'` day of ,202.0 by
HAof,,,, l!f4--
l('te,
IC%IfdRJ k,
Name of person aking st tement
�OR
Name of perso . along statement
Personally Known Produced Identification
Personally Known OR Produced Identification
Type of Identification '�_.
Type of Identification
Produced
/Prod/ucc�ed�7�
{Signature of Notary P Gc-State of Florida
{Signature
""""•„ CHRISTINE J. CO;
t{��)L.RComm'
State Flori
Commi n,. •^�,'•M�7
I„p, CHRISTINE J. CONWELL
Notary Public -State
issi y "5sftllla
-'
- of
• - assion # GG 017839
n # GG 017839
My Comm. Expires Aug 21, 2020
ices Au 21, 20Bonded
al Notary
thrm"
Bonded thin
gh National Notary
a;jlah�!
REVIE
PLANS VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 812/17