HomeMy WebLinkAboutBuilding permit appALL APPLIC LE 1 FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:—t2' N Permit Number:
a
- Building Permit Application
Planning and Code
ion Dives
ision Building and Cade 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: 1L'
Address: 531 1eo51 �. &
Legal Description:
Property Tax ID #: 3 Q SC)
Site Plan Name:
Project Name:
Setbacks Front Back:
-000 - Od
Right Side: Left Side:
Lot No.
Block No.
('DETAILED DESCRIPTION OF WORK:
L'i(�
hecd:-
CONSTRUCTION INFORMATION:
HVAC L Gas Tank
Electric El Plumbing
Total Sq. Ft of construction:
Cost of Construction: $__ .4800-00
Piping 1 �IShutters ❑Windows/Doors
nklers 1:1 Generator E]Roof
SFt. of First Floor: _
Utilities:Sewer Septic
Building Height:
OWNERAESSEE:
CONTRACTOR:
Name
Name:
Address: 53� T 5i{� �,�
Company: (
ff '1
City: IC1Ce Stater
Zip Code: 1' 4qs Fax:
Phone No. LiJ�• JrI R' !S2q
Address:510 k --Fu I
ikz-
City: f'bf.b I7(tfU,,
Zip Code: '3 *q r5� �1
PhoneNo.�4fgL— l-41.10
state: R.
Fax:
E -Mail:
Pill in fee simple Title Holder on next page 1 if different
from the Owner listed above)
If unt". of m
E -Mail:
. On (Y1
State or County Licen e:
ClkC 118 (p
SUPPLEMEWAL CONSTRUCTION UEN I.AWINFORMATION:
UEMW WEER. __
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Na�imble
ISE CO PANY: Not Amlicable
Name:
Ya,,
Name:
Address: -
o;_ Notary Public - State of Fonda.
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Address:
R• Phone
State: -
city_ State:
My Comm. Expires Au021, 2020
Zip; Phone:
FEE SIMPLE TITLE HoLom
Not Applicable
BONDING €€ MP _ . Applicable
Name:
COUNTER REVIEW REitl
_Not
Name -
Address:
Address:
City,
City-
ZIp: Phone:
.Zip: Phone:
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`C mAIFEMNUMwr¢ tt:ApIxicatiinisherebymadetoobtainaperunittodothe workand 3nscallatianasindicated_
I terrify that no work or ssiailation has commenced prior to the issuance of a permit,
wlmitit it In £imrifiiCt lNili'!a - _- a••••, •rs=yc+xsr.c way. aus#rs�azc stmt_ estriou e3Rc.To oundaa the subject structure
n1 applicatrle krom_= t3wners gssocr-don rules, bylaws or coo ants that may restrict or prohibit such
structure. Please consult 1-lxlm 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 heresy agree that I will, €n ail respects, perform fixe work
in accordancewithlteapprrned plans. the Florida 8ufding Codes and St Lucie County Amendments.
The fofowing building permit applications are exempt from undergoing a full cormcurrenry review: room additions,
accessory shucturest swi ninuM pools; fences, waft, sigos, screen roams and accessory uses to another Gaon stuential use
WARNING TO OWNER.- YMW %allure to Record a fie o.F C.urnmericeirdent may, result in Your paying terir:e for
improvements to your property- A Notice of, Commencement must be recorded and posted on the lobsite
before the first inspection. If you intend to obtain financing, Consult with lender or an attorney before
cor-rimpnirinswunruyr nr mrnrriina aaes.r Al..a-:x-,,.,€r
Signature of Owner/ iesseelcontractaf,*Agent for inner
STATE OF FLORIDA a { t , a Ian.
�OUPM OF UWl
The forgoing in was admovMAedged before me
€hisriiay of 2020 by
Name of person tement
Personally Known Qct Producati lderrtifsea&on
Type of Identification
Produced
SiMaturree of ContractorlUcense 4ol ter
STATE of FLaRiDA
The ing in
of it wasacLnowiedgebefore me
y � 4 by
Mic�t F G
!Name of pers7ollnaidnIg sta ent
Personally Known t7R Produced identification
Type of Identification
(signature of tit is 5ta"181NWE..
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cSEy;:33fimr20fkr , P �i+',StaaeERFSRJ.
CONWEI.L
Nolary Public -State of Florida
Ya,,
Commission - ° + 017839
Commissuill
comrrlrSsion ilia _ r y
o;_ Notary Public - State of Fonda.
_ 7
's"qr oe My Comm. Expires Aug 27, 2020
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x� Commissitseap'; Ot 1839
P,;; Bonded through National Nolary Assn.
My Comm. Expires Au021, 2020
Bonded through National Notary Assn.
RE1t4EmAr5 ZONING SUPERWSGR
PLANS tEl3fTiTfiilN
E
COUNTER REVIEW REitl
l REtiIEW
REVIEW REVIEW
Rev. 912117