HomeMy WebLinkAboutBuilding Permit Application I�
ALL APPLICABLE INFOMUST BE COMPLE!(ED FOR APPLICATION TO BE ACCEPTED.
Date: ." Permit
Number:
RECEIVED" MAR 217.017 .
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 Coln mercial -Residential
PERMIT APPLICATION FOR: .To Select from dropbox, click arrow at the end of line 5�
PROPOSED IMPROVEMENT LOCATION:
Address: -2 yf S TG.Mci(',1 n1 Lrl- pwE e._
Legal Description: /1L " 0 r;N 7
fL2- bloAC 2 6,4 -P%�
Property Tax ID#: �=13, �d -d.��a- d40-I. Lot No. Z�
Site Plan Name: Block No.
Project Name: ✓��oG ��..
Setbacks Front Back Right Side: Left'Side: 7, S
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION: . -,
Additional work to be pertormed under this permit—check all that apply:
HVAC _Gas Tank,', . _Gas Piping E _Shutters _Windows/Doors
Electric _Plumbing" _Sprinklers _Generator _Roof Roof pitch
Total Sq. Ft of Construction: ®-a Sq. Ft.of First Floor: J1AD
Cost of Construction: $ .;2 ��' _�� Utilities: _Sewer Septic. Building Meight:
OWNER/LESSEE: CONTRACTOR:
. -s
Name Ila Ie ,:_ .. >_.v:___ . ;' Name:
Address: .24'I diN; j>' + Company: U
City: �� 'C:`�' :State:�f. _Address: /O
Zip Code: JIq q'C( Fax: . "- City: kl1 1 c 1.e- State:`
Phone No. dacb3~ Zip Code: 9L'K Fax:
E-Mail: Phone No.. 772- �2216` _7L6
Fill in fee simple Title Holder on next page (.if different E-Mail:. YG v LOY�e - .� ��IIS
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.%"
l
SUPPLEMENTAL CONST UNION 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 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 undel-goinga'full copcurrency 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 len r or 77orney before
commenci wor or recording our Notice of Commencement.
s
SignrEF
of Owner/Lessee/Contractor as Agent for Owner Signature ofrLORIDA
ra /License o
STA FLORIDA STATE O
COUNTYOF Sk. COUNTYOF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this' \ day of WNc>L I` 20by this �.� day of ' 20\1_by
5a k-e 1C c.a v cJ lre ak c ' t c o o
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida-) (Signature of Notary blic-State of Florida)
Personally Known OR Pro ication Personally Known OR Produced Identification
Type of Identificat' L Type of Identification Produced
,�Pu DEANM%#GG 022020 '• IdARIE GIVENS
Commis Commissio ; DV WMAJ5SION#GG�$� l)
N�Q N No�ry PubticUn N ;o EXPIRES:December 18,7R'di:
%,,r✓fyoP: gondedTh .•;r ": gandedThruNotaryPublicUndorvri.. it
Revise 07/15/2014
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