HomeMy WebLinkAboutBuilding PermitALL APPLICA LE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: _ `� :Z0 Permit Number:
Y J .
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
PROPOSED IMPROVEMENT LOCATION:
Address: 05
t1torl AIL _Nefrg Cf. 34q5l
Legal Description:1Q,kQumac
P3 L-11yli'+ Q&L 101 LWS 1(o f 17
2�
Property Tax ID #: I�1 (rp [ - 00 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: LeftSide:
DETAILED DESCRIPTION OF WORK:
Li jc� Fo✓ ttice : ' instu (1 hew Cknvio>c 3 -brl
Sq S f 2Ur1 W t iln 10 16u) ext .
RUCTION INFORMATION:a
wor to e e orme un ert ispermit-c ec a appy:
V
AC F] Gas Tank ❑Gas Piping _ Shutters E]Windows/Doors
Electric Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction`: 5 Ft. of First Floor:
`� ��r�l
Cost of Construction: $ d-40- UV Utilities: []Sewer01Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name D1
Name: t
^ _ ,
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Address: !/I Ll 5 P ��PI)Vi AVP
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Company: Bay% N( Nl�tjlQ✓1 �� %1P YIG
City: I%bf� i�`P,CC—C. State: F
.
Address:5105` PrTU,rY104cL �AFr�` F1J
Zip Code: 3 Fax:
City: i'i)f� f 1 P iCQ� State: rC.
2
Phone No.Js
Zip Code: "3 5 1 Fax: Z1
E-Mail:
PhoneNo.�`(�'1_i1111 1
Fill in fee simple Title Holder on next page ( if different
E-Mail: 1��JI 11A_ i7tn brn0. A b'1
from the Owner listed above)
State or County Licende: CAC I $ IS 1$
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCMU LIEN LAW MATION:
OESIFaNER/ENGI3rlEER. Appliieable
Name:
MORTGAGE CDWANY. Not Applicable
Name:
Address:
Address:
State: _
zip:—Phone
£Sty: State:
ZiP: Phone: {
FEE SIMPLE TITLE Not Applicable
Name:
BONDINGCOMPANY- blot Applicable
Name:
Address:
Address -
City:
City -
Zip: —Phone:
Zip: Phone:
arsvcacrcja nacRs-tvKAr"Uvan: Application ishereby made toobtain a
permittn dei the work and instaifation
I mriity, that no work or installation has commend prior to the issuance of a permit
S',Lucie County makes no reoresentation that is EraiatirlE a nPrmir v ti �z $ rtsesn ti a a r : + x .w a __-z:_� .
In consideration of the granting of this requester{ perrnig I do hereby agree That l will, in all respects, perform the work
in accordance with the spPms plans fire Florida Braiding Codes and St Lucia £ounty drnendmmts-
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swaamung poor fences, walls, sigrrs, screen rooms and accessory uses to another non-residential use
VARMING TO OMMER: Your #allose to Re€.ord a Notice OF Comortencentent way 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 tender or as attorney before
commencirie work or recordin2y your Nri!'m of Pnmm cn mcn+
Rev. 8/Z117
Signature of Owner/ LesSe2 Cmbado SAgmt for wrier
Sigratrire of i DntractorAwense Bolder
STATE OF FLORIDAG 1 - Wit
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STATE€ F FLORIDA
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Theoing instrument was acknouiledged before tete
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The fn orng instrument was acknowledged before me ±
,this ay of MGX( h 20_20 0 by
this day of Y1 mch 2QZ_ by
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Name of persovMidrigstAtement
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Name of persoyInaking statement
Personally Known OR Produced Ider ti ication
PersonallyKnown V OR Produced identification
Type of Identification
Type of Identification
Produced
Produced
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DATE
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DATE
COMPLETED
Rev. 8/Z117