HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABO INFO pAUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED-
Date: ( Permit Number: �� � �
Building Permit Application
Planning and.DevelopmentServices
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 -
P�ROPOSED IMPROVEMENT LOCATION:
Address: a q(P N C. 1Y) \<,Z;4 t `5�4- 'ram'®T-1 � L A-,L t C.Q- �7L
Legal Description: kileY Q
Lrc U1(l i- C--- -\\41 Rn
FropertyTax iD#: �Z' '�000 Lot No.
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Site Plan Name: Block No.
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Project Name:
Setbacks Front Back: Right Side: Left Side:
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DETAILEUDESCRIPTIO'N OF W.6111
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;CONSTRUCTION IN'FORMATI.O.N .
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itiona .wor to e er orme under this permit-check a apply:
QHVAC Gas Tank ❑Gas Piping _Shutters Windows/Doors
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Ll Electric ❑Plumbing OSprinklers Generator Roof I�i2 Roof pitch
Total Sq. Ft of Construction: SO. Ft.of First Floor:
Cost of Construction Utilities Sewer LJ Septic Building Height:
a-OWINM IESSEE CONTRACTOR:
Name lr�.Q Y' A j�'. RS - — Name: �� t Lt�V�261`SL
Address. l Company: x�
City: State: Address: PCLJCjLL �ck3H/i 0�
Zip Code: Fax: City:[ lip +01 State:_O
Phone No. -7 o� a J a�a� Zip Code: � �?� Fax:
E-Mail• Phone No. �•'I�j 8�U 1
Fitt in fee simple"title.Holder on next page(if different E-Mail: )n
W & C)ft�P6�_J Vt7o�' C�
from the Owner listed above) State or County License: a 3
if value of construction is$2500 or more;a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL,CONSTRUCTION LIEN .LAW INFORMATION.
DESIGNER/ENGINEER: —Not Applicable MORTGAGE COMPANY: —Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: —Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
I Iertify that no.work or installation has commenced prior to the issuance of a permit.
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.
Inlconsideration 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,
a Icessory 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 our Notice of Commencement.
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Signat r of Owner/Less e/C tractor as Agent for Owner S' na r tractor/License Holder
STATE OF FLORIDA STATE OF FLORIDQ�������
COUNTY OF .(2- k(Q�A j .6e ate.._ COUNTY OF'
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The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this ��Iay of 20 Eby this day o��:�(� 20 11 by
(�Q YY1a LA rm
(Name of person acknowl Bing) (Name of person acknowledging)
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I(Sign ture of No r Public-State of Florida) (Signaturdhof Notary ic-State of Florida)
Personally Known OR Produced Identification 4_10 Personally Known�X OR Produced Identification
ype of identification Produced Type of Identification Produced
�'Commission No. � lX w ommission No. ;,o�.... •:4.: Kall)Y POOLE ?
KELLY POOLS ': MY COMMISSION#FF066990
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Revised 07/15/2014PF.',`OQ''' EXPIRES January 12,20i8 ,- (407)398-0159 FloridallotaryService.com
(407)368.0153 FlorldallotaryService.com
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