HomeMy WebLinkAboutBuilding permit applicationALL APPUCABIIE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: -2 0 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 II�
PROPOSED IMPROVEMENT LOCATION:
Address:_ft0(Z
Legal Description:
Property Tax ID #: 1313 - 6ol- 00 4 -000 - 3
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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A1 5tP+ten to'(b 5Kw heat
Lot No.
Block No.
CONSTRUCTION INFORMATION:
Xrtl a workto e e orme under t-checkispermit a apply:
HVAC Gas Tank []Gas Piping _ Shutters Q Windows/Doors
aElectric M Plumbing Sprinklers Generator 11 Roof
Total Sq. Ft of Construction:
Cost of Construction: $ =)O
Sq. Ft. of First Floor: _
Utilities: 0 Sewer Septic
Building Height:
OWNERAESSEE:
CONTRACTOR:
Name
Name:
Address:� So a Ro� Wfb :x
n nn-- !!E�
Company: goyia Pd NrAi h jVl a � NPifltiq
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J4'IC .
City: fl�'� PitrCQ. Stater
Zip Code: 34451 Fax:
Phone No. 121- Ligq- A cI8(0
Address:5(0 6 P 1U,0Ak.G
City: ibrb- IRe CZ State: R_
Zip Code: S 4g s i Fax: -7?-?-- 4 0 -373i
PhoneNo.'M- "&(-i- 14-1
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: ChC 148
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
--),uF1`LtMtNTALCUNSTRUMON! UEN LAW -INFORMATION- -
DESIGN IVGENEER.
N ____ Not Applicable MORTGAGE COMPANY-_ Not Applicable
time. Name:
Address: Address:
City: State: City: State:
Z7[P: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER. � Not Applicable
City: - --
Zip: Phone:
naa.mva-.a aa...--.
Address:
Zip:
_Not Applicable
. _ , , 111. r. a: I`WliCauon is nereoy nradeto 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.
StfiiLucie
ch iCouurrr% with representation that is granting a permit will authorize the permit holder to build the subject structure
structure. Please ict consult nyy applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
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 iluilding 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 use to another non-residential use
WARNING TO OWNER. your #allure 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 fender or an attorney before
Commencing work or recordinS vnnr Nritir•a ni fnmman�a.nnnt
$lgrlatUFe Of Owner/ Lessee/Contractor S Agent tOF corer
Signature of contractor/License tickler
STATE OF FLORIDA C1 j , , n }
COUNTS' OF S1 1.0 4 1
STATE OF FLORIDA �� l�
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this j3lY day of_. ,rL�'1 , 24 20 by
this1.H-day of m/A,YGk 2D 20 by
Mickod F: go !e.
Nticl�ael F !�
Flame of person aring tement
Name of persayfruaking star ment
Personally Known V OR Produced Identification
PefsOnNtYKnOwn-V OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(Signature of Notary P - -State of Flornda )
(Signature of P -
r`nav'>"�
Commission ,.."aa'v';�., 'CHRISTINEW '�.�,
NWELL
CHRISTINE J. CONWELL
Commission ;:��P a�,'
o. Notar Public - St$�pl(�lorida
Notary Public -State oMFloritla
°• ` - �'= Commission # GG 017839
=• ' Commission # GG 017839
°^ do M Comm. Expires Aug 21, 2020-
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DATE
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DATE
COMPLETED
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