HomeMy WebLinkAboutBuilding Permit Applicationy
ALL APPLICABLE INFO MUST'BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: i - 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).46271578 Commercial Residential
PERMIT APPLICATION FOR:. To Select from dropbox, click arrow at,the. end of line.
PROPOSED FMPROVEMENT LOCATION:
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Address:\M� S..OeesacN ���#`�\`2SiS2J►1`�'L�W�ih7
Legal Description P -,C cw , �� �'�. -�. � �y�o- �C" `�i�� :- \`��1 Aga
Property Tax 1D #:`'\� - �0 "\�� -��� -� Lot No.
Site Plan Name: 0 13-t Block No.
Project Name:
Setbacks Front' NQi Back: `J 'Right Side: Left Side:
DETAfLED' DESCR,IP.TION "OF WORK-:
Mom._
CONSTRUCTION, INFORMATION '
'Additional work to be nertormed under tis permit -check all that apply:'
HVAC O.GasTan'k Gas Piping _ Shutters Q Windows/Doors
Electric _Plumbing . Sprinklers Generator _.Roof
Total. Sq.. Ft of Construction.: �o S . Ft. of First Floor:
Cost of Construction: $ Utilities:Sewer Septic Building Height: �t
OER/LESSEE WNP.:CONTRACTOR:
- .
Name Q Se-�.
Name:
Address 1Q3 �J �� S -i
Company: = -z S nsk�P
.State:c�
Address:\` \
Zip Code: \ Fax:
City: .State:S1- .
Phone No.1 AD rJ -'-3
Zip Code,3c�. Fax:
E-Maili
Phone No.�J:'--SQ DO
Fill in fee simple Title' Holder on.next page (if different
E-Mail:
from the Owner listed above).
State or County Licenser \a
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. I
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION -
DESIGN ER/ENGIN EER:
_ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
S . -
_
Name:
Address: Q30
Address:
City: State:
City:'g�.,� �ar�or State: L.
Zip:'&A tB Phone: %pg,-Q$a
--713
Zip: Phone:,
FEE SIMPLE TITLE HOLDER:
_ Not Applicable
BONDING COMPANY: _Not Applicable
Name:'
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
II St.. Lucie County makes.no representation that is granting a permit will authorize the permit holder to. build the subject structure
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with 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 Building 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 uses to another non -residential -use
WARNING TO OWNER: Your failure 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 lender or an attorney before
commencing work or recording vour Notice of Commencement.
`Signature of Owner/ Agent/ Lessee Signature of Contrac r/License Holder
STATE OF FL4MWA STATE OF FLORIDA
COUNTY OF Syt,a-nrj COUNTY OF Maces r�
The forgoing instrument was acknowledged before me The fooing instrument was acknowledged before me
_ „ this Iay of Si ?-r 20 14 by. this a day of 't 2014 by-.
it � a4 -c � � �rz.•FdZ : R o C� �-12.—r �•c Av �g 'S _ cJ� � � �� .
(Name of person acknowledging) (Name of person. acknowledging)
(Signature of Notary Public- State of )C(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification Personally Known r d ed Identification
Type of Identification Produced r ftt luyL 1,�io..�,o Type of Identification Prodfed
.F ,"��
N 0-2— '7 � :. ' , HUNTER
Commission No. ' • : (Sea[)"', Stale of Florid,
Commission No.t�(2�t �� (Seal) M( )' A
;^9� .y c s Jan
Revised 07/15/2014
`_4,Wary Assn,
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My Comm. Expires Apr 13.• 70