HomeMy WebLinkAboutBuilding PermitALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED j
Date: �L 11 J 2 1 Permit Number:
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:
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name:_
Setbacks Front
-000-
Back: Right Side: Left Side:
Lot No.
Block No.
DETAILED DESCRIPTION OF WORK:
Gi Q i r l it C. SA s(ull npw 3.5 -byl , 15 sea tznYi0x R&+ tauv
4 S�rtPlC 54s4zW wi-hn 5KO h&L+.
CONSTRUCTION INFORMATION:
rtl a workto e e orme under
this permit -check
a apply:
X_ HVAC Gas Tank
❑Gas Piping
Shutters
Q Windows(Doors
Electric Plumbing
Sprinklers
_
Generator
Roof
Total Sq. Ft of Construction:
S Ft. of First Floor:
Cost of Construction: $ 6 5 0- 0()
Utilities:
OSeptic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
t (
fnlrt
Name: ,
Address:
$ o�Iv25 (
Company:BayIQ_ Air NnixvftiaA£ HuReq
TIC,
City:AY I ((l✓ State: R,
Zip Code: 3L151 Fax:
Phone No.-7 %FLily -L}03%
Address:5(d5ATUfniNik1L
City: i'U(-bi R fc& State: R,
Zip Code: S*g5!I Fax:-73�--4&(e-373i
Phone No.- d-- 'Ct01-41+1
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail:
State or County Licen e:
If value of construction is S25W or more, a RECORDED Notice of Commencement is required.
Si.�PPT1�� CL�AISTR�I�(3R4 iiE�i i.�lt lt'�F£3RA3T�td:
�ES16[�Ei€jETIS##O4EER;
Name:
_ Not Applicable
15RtiRTfiA6E COMPANY-
game:
Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zap: Phone:
State:
FEES#M4riE'Pl'i•1E ##E�i.#)�
Name:
s Not Applicable
Sbii CO�P1FAhiy':
—NotApplicable
O ERJ CONTRACTORAFFIDVIT; Application is hereby made to obtain a permit to do the work and instal ation as indicated.
i certify that no work or installation has commenced prior to the issuance of a permit
St LucieCoun makes norepresentationthatisgrantingagermtwill authorize the p t. holder tobuild the subject structure
which is in with any applicable Horne Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult senor your Home Owners Association and review your deed for any restractrsms which may apply.
In consideration of the granting of this requested permit, I do hereby agree that 1 will, in all respects, perform the work
in accordance with the approved plans the Florida Building Coin aryl St. Lucie County Amendments_
The following building permit applications are exempt from undergoing a full rnnarrrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, sawn rooms and accessory uses to another non residential use
WARNING TOO ; Your failure to Record a Notice of Commencement may result in yaw paying ftatare for
improvements; to your property. A Notice of Commencement must he recorded and posted on the jobsite
before the first inspection_ if you intend to obtain financing, consult with Sender or an attorney before
cammendn work or recordingour Notice of Commencement.
Rev.812117
Name.
Address: dress.
Sgnaturea=Owner/Lessee/Coniractoe ,Agen{;nr wrier
Stgsratureof(:ontractorilicenseptto�ider
STA�OFFLt}Ril9A �%r• �C�Qi
S—TAi-Ea�F#.OR#$iA Si. l.U.�,(�
£OUIiITY OF
COUNTYOF
The iorgoir�
tills IdayLr202) by
TheiQrgatrtgirrstrnmentwas acimowteaged before me
this 1�"day ofrr2tby
Nentwasackninviedgedbeimeme
�!
MiC% —Fl &ViU
Name o€person Waking tement
Name of perso .along sta mem
Personally Known OR Produced iderrteCr�{ian
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Prod1/uced?/
�/��
��/f/Jo /��/� �� �
9.
{Signatrsreo ,ver r .. tad J��b � L
(Signature of Ncta f ubtic-Slate of F"wrida )
Commission No. CHRIST�,�j#LE CONWELL
_ `? • �?. otary Public • State of Florida
COrimr55rOn i ml stun M GG 964(62a1
;.. ..; Notary Public •State of Florida
� Commission # G7 984701
My Comm, Expires Aug 21, 2024
Bonded through National Notary Assn.
My Comm. Expires Aug 21, 2024
-
NatlOrpt
otary Assn.
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