HomeMy WebLinkAboutBuilding PermitALL AF
Date:
INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
LA 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 IL)
PROPOSED IMPROVEMENT LOCATION:
Address: lt#�i4_
Legal Description:
Property Tax ID #: %, �0 ?1- 11 - 00 2 —b tw/.A Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: LeftSide:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION: II
[�oJHVAC l_J Gas Tank (JGas Piping LJ Shutters
11 Electric 0 Plumbing Sprinklers 11 Generator
Total Sq. Ft of Construction:
Cost of Construction: $ 440-00
5 Ft. of First Floor: _
Utilitieso Sewer F-] Septic
Windows/Doors
L� Roof
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name $
Name: det
Address:
��
n_
Company: fJi7�d% illi
!/L�, '�'� gg� 7
UlirrJl dyi�I/A/A s' HQIiGrJYte.
City:A511fP�(fl'll]2j.0 BfQ. State: Ft.
Zip Code: 33 OG q Fax: - 1
Phone No. i'1XIR.r& : 0 hley 13p i rol 584 -484-
Address:510A-TLCYVIpi(CSL aJLKjL,
City: fbCb— (�t'Q,fc&
Zip Code: '3 41511
Phone No. -1'19- qkJ-41-+1
State: tGC
Fax: -7'1.L- 41e 0-373 1
E -Mail: Qn141
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E -Mail:
State or County Licen e:
CAkG 1115 I Z
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION
DESIGNER/ENGINEER: _ Not Appiic abte
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:
OWNER/ CONTRACTOR AFFIDilIT: 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.
D
Home
build the subject structure
ty restrin a a prohibit such
is which Y pply.
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 £odes. and St_ Lucie Cmmty Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, wads, 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 your paying tivire for
improvements to your property. A Notice of Commencement most be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an attomev before
Signature of Owner/ Lesseelco actor Agent for wner
'='z -/ 19
Signature of Contractor/License-Holder
STATE OF FLORIDA CC,�, ' STATE OF FLORIDA f
COLINTYOF �1. ►e COLINTYOF U4( I
The forgoing instrument was acknowledged before me
this 1 day of M&acn 20 ?A by
pkhoel F Boyle�
Name of person aking stAtement
Personally Known OR Produced identification
Type of identification
2&4az a &n4ya_
{signature of Notary blic-State of Florida j
c HHISTINE J. CONWELL _.
Notary Public - State of Florida
Kev. alzj-LI
The forgoing instrument was acknowledged before me
this I0h day of MAC , 2020 by
i'dw F &tlel
Name of persopfmaldog stat meat
Personally Known V OR Produced Identification
Type of identification
sxzazzz
(Signature of Notary Pub tate of Florida)
PLANS
REVIEW
i.HHISTINE J. CONWELL
Notary Public - State of Florida
21