HomeMy WebLinkAboutBuilidng Permit applicationALL APPLICA LE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: 3 /��lr/� Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division /
2300 Virginia Avenue, Fort Pierce FL 34982 V/
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:
d
r
i C4 345
Legal Description:
/r �wDC.QF
I UVKi� r11 ti
Property Tax ID#: 23o3'2111 -002 '000 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
siaM yltw -ion t s�
C l a c t� lilt J W i1 h tp Kct) h2u .
CONSTRUCTION INFORMATION --
rti a wor to (e ne orme under this permit- check a apply:
_ Add
L AC J Gas Tank ❑Gas Piping _ Shutters ❑ Windows/Doors
01 Electric 0 Plumbing Sprinklers Generator 0 Roof
Total Sq. Ft of Construction: 5 Ft. of First Floor:
Cost of Construction: $ �r�l�0 • �� UtilitiesSewer ElSeptic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name
( .,
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Name:
Addrr ss:
SiAve,
�',., nn�� !L
Company:Poym- N e
y
yi�tl/A/A , HuRn4ri_yt�.
City.'Vor �,l�f) la(b State: �-
Address:510 A-FufnP k.L �1i� 9d,
Zip Code: S M, (Vel Fax:
Phone NO"r0ni FP,5MI(.C-ItrlArk -"a-901-g431
City: fb(-b—1Ref(,9i State: R_
Zip Code: S4g5`��1 Fax: 7V Lt(plp-.373-1
E-Mail:
Phone No.-"g- ^&(-i-t•ty-t
Fill in fee simple Title Holder on next page (if different
E-Mail:
State or County Licen e: ems!$ I '3 f $
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPP'LEMENTALCONSTRUCrION LIEN LAW INFORMATION:
DESIGNERIENGINEER: _ Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: y Not Applicable
Name:
Address:
City:
Zip: Phone:
SODDING COMPANY- _Not Applicable
Address:
City:
Zip: Phone:
a+vvrvMV c.assv I ecrte.i use Attatsys t : AWiCation 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 Cou Y makes no representation that is granting a pi rmit wilt 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, waits, signs, screen moms 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 recording our Notice of Commencement
Signature of Owner/ L LWCootract r 4s, Agent for caner
Signature of ContraactorjLicense, H der
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF • Ludt
COUNTY OF
The rgoing instrument was acknowledged before me
UVC�
The forgoing instrument s acknowledged before me
this �}1s day of . 2f3 2 by
this W day of It rLin . 20 Zo by
Whao F. 13oyle,
&ylg,
Name of person aldng stAtement
Name of perso along statement
Personally Known OR Produced iderstification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
12
/ n
{Signature of Notary Rc-State of Florida)
{Signature of Notary Pu - State of Florida }
Commissi
ti'p'ar'r o""'/�CMRCSTiNE J. CONWELL
Commsssio r.--CFAiSTINE J. CONWELL
°A`�:'s
Notary Public - State of Florida
r°�Notary Public - State of Florida
- . •E Commission # GG 01783
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DATE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17