HomeMy WebLinkAboutBuilding permit app ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ((��
Date: Permit Number: L O&I-I
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)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at-the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: C:XQd
Legal Description: e s o _d�C �l 1 arG�L 0
Property Tax ID#: 4SO--� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF-WORK:
CONSTRUCTION INFORMATION:
Additional workto e e orme under this permit-check a apply:
❑HVAC Gas Tank []Gas Piping _Shutters ❑Win'dows/Doors
❑Electric ❑Plumbing []Sprinklers ❑Generator ❑Roof Roof pitch
Total Sq. Ft.of Construction: S . Ft.of First Floor:
Cost of Construction.$-I I oo0. yU Utilities:iSewer❑Septic Building Height:
OWNER/LESSEE: CONTR CTOR
Name or ar-c—, r' V_ Name: (_lU
Address:Q&c-> fie. S -PL�Vim, Company: V ° Oct i l
City: State Addrs
�ess: a
Zip Code340,S'1 Fax: City�73 t M r_,e. State.
Phone No.'"1 P ��__o��d �c `l Zip Code3q�. Fax:
E-Mail: Phone ��-
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:S-1 .DPJ(p 5 D
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: s _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name:`n�ey— UJCl Name:
Address: SO �kk 01 Address:
City:-Ipul-�-Sk State: 1 City: State:
Zipv��l�r�3 Phone:'�1"la`c�lQb'(44-)4 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.
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 our Notice of Commencement.
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Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF COUNTY F ORIDQ— L('Q STATE OF FLORIDA (�� �����
�� �� t-t4 l COUNTY OF < J
The fr mng instr ent was acl nowledged before me The forgoi instruct was acknowledged before me
thisday of ltiu 20 1by this day of Gt�+� 20 (� by
4jle
(Name of persona owledging) (Name of pe
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Ident fication Personally Known OR Produccdentifcation
Type of Identification Produced T _ (, Type of Identification Produced
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Commission No. O .�a���u deal) 3�i7l-2019
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'r. . Notary Public StateFlorida. ?�� �`�: LINA UPNOL
Notaru p-
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Revised 07/15/2014 :F�F� `:My:Oom n:t:06S Se +,F ,oc Oommission#FF 92197 a
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DATE `
COMPLETE �� ►I
INITIALS
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