HomeMy WebLinkAboutBuilding Permit Application 0_
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: r� Permit rmit Number: 1
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Building Permit Application FEB p 3 201?
Planning and Development Services
Building and Code Regulation Division PERMITTING
2300 Virginia Avenue,Fort Pierce FL 34982 St. Lurie County, FL
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,IOCATIQN:
Address: r a(;X
Legal Description: eU ccu_ U ` L-14 7
KAe.f 3g1 a&N 34:16 239Y
Property Tax ID#: ir//Q � J' On�f Lot No. T-
Site Plan Name: V Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
D,ETAILED.DESCRIPTION OF WORK.
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CONSTRUCTION INFORMATION-
Additional wor to be Dertormed under this permit—check all apply:
11HVAC Gas Tank Gas Piping _Shutters Q Windows/Doors
Electric Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: (/\ S Ft.of First Floor:
Cost of Construction:$ uV Utilities:]Sewer D Septic Building Height:
OWNER/LESSEE: CONTRACTOR
Name L Name:
Address: v Company: Q, ( ( --ree✓C C/Vt.
City: State:�1� Address: XA
Zip Code:Tel Fax: City: Stater
Phone No. -- 70-9J C '7 Zip Code: '7,1 �X7 Fax: <61 qDlqby 7f
E-Mail: Phone No. -7-z
Fill in fee simple Title Holder on next page(if different E-Mail: a 2iC \AYDY C pC tV�
from the Owner listed above) State or C my License: t I5_2517�
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 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�1,ner Signatur ntractor/License Hold
STATE COUNTOY OF FLORIDA ��( � � r Q_ STATE OF FLORIDAr� �C
v wL COUNTY OF
The forgoing instr�,ent was acknowledged efore me The forgoing inst ent was acknowledged before me
this day of 20l by this day ofq 20 by
l "�(I S 51 16t �•
(Name o person acknow ging) (Name of person ckno dging)
(Signature of No ary Publliic- ate of Florida) Signature of ary c-State of Florida)
Personally Known FOR Produced Identification Personally Known "*� OR Produced Identification
Type of]der Type ofIdegUt oduced
`Ot'{tY P46•t'
=°ot'"�""°` SUNSHINE OWEN MODRIC :�:
;: SUNSHINE O+J4rE
_: �I p Commissio N¢. : : N�0DRIC
Commission fop: _ mmisSIO�Y �N112913
;o. GOIM"MISSION#FF112913
bQ EXPIRES April 25,2018 .o�
..OF M1•.•" '...�FR P•r• EXPIRE
(407)39M153 FloridallotaryService.com (4U7)398-01s� Floria•,r1,lary5ervice.com
Revised 07 15/2014
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DATE
COMPLETE
INITIALS
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