HomeMy WebLinkAboutBuiiling permitALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TQ BE ACCEPTED
Date: U1112-0 Permit Number:
Building Permit Application
Planning and Development services
Building and Code Regulation Division /
1300 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: 52D5
W5G . A, ( 3uR51
Legal Description: flolidul S !' T 31Sµg
Property TaxlD#: DKI - -ODD- Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
U Ice. For U (Q : - it,S+at [ new LeVln0x 2 -Fon, « SEeiz
5r& Al e. sc,s+r m wifh s <o htak
RUCTION INFORMATION:a
wor to e e orme un er t is peaAC Gas Tank ❑Gas Piping _ Shutters Windows/Doors
V
Electric —Plumbing Sprinklers Generator ❑_Roof
Total Sq. Ft of Construction:j SFt. of First Floor:
Cost of Construction: $ J I �• Utilities:Sewer Septic Building Height:
OWNER/LESSEE
CONTRACTOR:
Name . "' a)Q f�
Address: ' ''/(J('nP5 Gr
Name: 1
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Company: c
Address:5(d A L
Tufty t
City: ��iifCt State: Fi.
Zip Code: �t 51 Fax:
Phone No.� Z�Sf 1I, g g
E -Mail:
tt
City: r0��'�t?fC•2� State: �
zip Code: '3 5 Fax: 73a-- 460 -.3731
Phone No. -`(D-- 4fp(-414-1
FII In fee simple Title Holder on next page { if different
E-Mail:�(1 nA_A tlir �in0. C't5 fYl
from the Owner listed above)
State or County Licene: CAC 181 S I a i9
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
iCiPFLEMEWAL a)WFRUICTION UEN LAW INFORMATION:
`
DBIG WGINEER:
Name:
_ Rot Appiacable
MORTGAGE AINY:
Name:
_blot Applicable
Address:
,mn1,sS4$asUG 017839
Address`
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Zip: Phone
State: -
City:
Zip: Phone:
State:
FEE SIMPLE 1ME HOLDER.
Dame:
Not Applicable
BONDING € o pA :
Name,
—NotApplicable
Address-
Address:
City_
SUPERVISOR$A
Zip: Phone:
Zip: Phone:
REVIEW
c ...vvxex ssms�exu scgxxxxumsswi umtiI tftolliiig d permit win aumor�Zetie Ft.. Molar TO build the Subject structure
which s in With any appfimble tome Owners Association rales, bylaws or �eenantsthat may restrict or prohibit such
structure. Please cnsisu9tm-ute year r Home Owners Association and review your deed for oily restricourm which may apply.
In consideration of the grarddi%ofahis guested permit; I do hereby agree that I will, in all respects, perform the work
in accordance with the ap d plans, the Florida ung Codes and St_ Lucie County Amendments.
The following building permit applications are exempt from undergoing a full mncunency, review: rosin additions,
accessorY structs€res, s"-vimm#M; sols, fend, wails, signs, screen room and accessory uses to another n€rn-residential use
WARNING TO OMWER. Yorar failure to Record a Notice Df conmrienceinentmay restart in y rpayitsig swke for
improvements to your grotty- A Notice of Commencement mutt be recorded and posted on the jobsite
before the first inspection. If you intend to obtain fmancine. consult with lender nr an ata€impu h alma
Si��riarare o= Owner) Contractor s Agent for caner Sigreatvne a: CorctractorJtscer;se iioYder
STAr�UI�rlN OFFLORIDA51 d� COU FLORIDASTATE OF —if.
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The forgoing" entwasadmowiedgedbeforeme
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Name of person/naldniI StAtemem.
Personally Known 4R Produced ideirtifiicatton
Type of Identification
Produced
the forgoing instrume€rtwas ar mowledged before me
itiis�dayOf , J U&O 2020 by
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Name of perste . nalling stat ment
Personably Known V OR Produced Ideiitiiicaffon
Type of identification
Produced
(Signature of N
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WELL
Nolary Public - State 01 Florida
Commission No: . =
,mn1,sS4$asUG 017839
Commis=.
My Comm. Expires Aug 21, 2020
Ended ibau, � Nffinnal Notary Assn.
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SUPERVISOR$A
REVIEW
REVIEW WREVSEA517FOUMER
;ev.
Notan, i "ac- State
CHRISTINE J. CQ�QWEEIi�L
ota,y Public - Stat¢'61't7orida
Commission # GG 017833
r Comm. Expires Aug 21, 2020
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