HomeMy WebLinkAboutBuilding permit applicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 4._ Permit Number:
t iJ
Building Permit Application
Planning and Development services
Building and Code Regulation Division
1300 Virginia Avenue, Fort Pierce FL 34962
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line ('
Address: Ie(p
Legal Description:
Property Tax ID #: -5oo - 021 3- 000-3 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Utice. -(o( Uyv. Sy,stA new [thocg 3 lzm ks se, etz sfllt ACC CVc&t
:51 S+ewl with S U back. tkf km -4 -
Lv-JHVAC L. IGasTank UGas
11 Electric 0 Plumbing OSpr
Total Sq. Ft of Construction: q
Cost of Construction: $ 52oa o 0
Piping L_IShutters
ars L. I Generator
S Ft. of First Floor: _
Utilities: 0 Sewer F]Septic
F] Windows/Doors
t 1 Roof
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name �,trna p t�p�I�(r��
Addreffss:kQ(0�2 l(
Name:
Company: ( !T
City: yU(k 1{ (Ct State: 4-
Zip Code: 34151 Fax:
Phone No.M,. - 5-7% - &Y 2=5
Address:5I0 P TU,fi I ()
City: 66�Aerc& State: r -t
Zip Code: .3 i'%E} S�! Fax: 77.7-- L{&0 -37'3'1
Phone No --U.1- 4-W-4(4-1
E -Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E -Mail: *[=9 Wa irin0. CO (Yi
State or County License: CAcC 181818
ouui.c m l ualamencemenx Is reQWrea.
IMORTGAGE COMPANY- Nor 1: FEE SIMPLE 111LE HOLDER: NotApplikabte BoNDinGcOmpArm.
O"EEt[ CONMCTM A DWr- ApOmattm ishereby madeto obtain a pmnv-Lto Bothe work and EnsWL-,bon as uedirated.
I certify thatno work or i.nstai anion has commenced prior its the issuance of a permit.
St. Lucie Ocmalresnorepresentat�#iratisgrantisgagermittwill authorbethep ehAder€o#n�the suhjectsisucture
which is in with a y ilificabfe dome Owners Association rules, bylaws or and ere ve ants that may restrict or prohibit such
strotaure- Please consultnm #as your Home Owners Association and review your deed for any restrictions which may apply.
In consideration of the grarding oithis requested permits I do hereby agree that I wik in all respects, perform the work
in accordance with the approvedplan,, the Florida i�ilding Codes and St. Luce county Amendments.
The following building permit applications are exempt from undergoing a full concurrency, review: room additions
l accessory structures, tures, swtmnrueg poor fences, walls signs screen rooms and accessory uses to another non-residential rise
t TO O Yaw failureto Record a of Commencer result in your paying twice for
improvements to your property. A Notice of Commericement must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain fsnandng, consult with tender or an attorney before
commencingwork or record nr Notice of Commencement.
e
Rev. 8/2117
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Address:
T. '
f � [ Phone:
Address: Addrew.
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Signature cn(3wne€/ LesseeJCarrtractnr� Agent far Signature of Corr!ractar[Licens�e `Holder
STATE QE FLORIDA L STATE e'3F FLORIDA c� f • ,,, _
CQtINiYQF S7 i U�i� CQL14QF LbU..IL7.
The forgaing irustrurrrerttwds acRmoui!edged before me The fa sing instrument was arorawiedged before me
ihis�-�'� day a; _ 20 io 6y this]r is day of {_gyp_ f_j(-!_ .2tf�o by
Flame of terruerri Name of aktngsta east
Personally inossnr €1k Produced ideation Personally Known OR Produced identification
Type of Identification Type of Identification
Produced PrJ. oduced '
lSignahae of N - f €arida (Signa — —
••F��Y pUA HRSTINE J. CONWELL
Commission ;zognr CHRISTIN��I NWELL Notar Public -State of ,
Y Public' - to a of Florida _- Commission # GG 017839
• Commission # GG 017639 '�, My Comm. Expires Aug 21, 2020
My Comm. Expires Au 21 209n Fara vE•
o e trough National Diary Assn.
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