HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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Building Permit Application GEAR 2 4 201?
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 dropb,ox, click arrow at the end of line P4 `C'r
PROPOSED 1NIPROVEMENT LOCATICJN
Address: ( Qe h Ave F-7L
Legal Description:-FIVer •f-;7 ——614 1 1,C/
Property Tax ID#: �Q- _�/Q- �l^I -LW Lot No.
Site Plan Name: Block No.
Project Name: b
Setbacks Front Back: Right Side: Left Side:
bETA'ILO D ION dF WORK
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,o r2 2xr5 ` n -k-)GLICL l�-erz utJ 40 C 6n , �50 1b.
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CONSl'R'UCTIC}N INTO;RIVATIaIU
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Additional work to e e orme under this permit-check a apply:
�HVAC Ei Gas Tank ❑Gas Piping Shutters ❑Windows/Doors
Electric ❑_Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: .,�;?qL S . Ft. of First Floor:
Cost of Construction:$ ���() Utilities: Sewer Septic Building Height:
01NNER/LESE y CONTRACTOR'
Name 1voin rt Name: S
Address: :�!? S f Company:
City: Aiddre4mon State: Address: ?J-3C4( `JP ':;k2 Q✓ Sf
Zip Code: 10CJ Fax: City: �51AA Stater_
Phone No._'77P 3W 9 Zip Code:3yQ4r_7 �o-�, Fax`.��2 0�l �7eo-3
E-Mail: Phone No. �c� rto c 097aC/ /"
Fill in fee simple Title Holder on next page(if different E-Mail: Ck�_ L' (/��C�C�ft�S -e&oA
from the Owner listed above) State or County I- ense: ('CC I'.3 _&�-7 t/
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. �T
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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, bylpws 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
comrpe,ricingwork or recording our Notice of Commencement.
1hZW (ap �%� s
_Signature of Owner/Lessee/Age Signatur of Contractor/ icense Holder
STATE OF FLORI STATE OF FLORI A
COUNTY OF P`f!�1 COUNTY OF 1WIr h r\
The forgoing instrument was�^cknowledged before me The for oing instrument w acknowledged before me
this day of �U I 20 L3by this�� day of 20 by
114a A t(auj LQS � c
(Name o erson acknowledgin ) (Name of per on acknowledging)
(Signat)a of Notary Public-Stat o FI n a) (Signature f Notary Public-Sta o FI rida)
Personally Known f< OR Produced Identification Personally Known >,,—OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No.FEsn I 3LI� (Seal Commission No. CCAqF se
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INITIALS