HomeMy WebLinkAboutPermit Application lot 36 DS 3.17.2021ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
7COCINTY
L It O 1 D R -�
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: tip?
Property Tax ID #;
Site Plan Name:
Project Name: _
Setbacks Front
- / CAW ~ 0UJ I CV-0 -
Back: Right Side:
DETAILED DESCRIPTION OF WORK:
Left Side:
Lot No.�
Block No.
Haaitionai worK to Ile ertormea unaer tnis permit — cnecK ail apply:
�HVAC F] Gas Tank Gas Piping Ll _ Shutters ❑ Windows/Doors
Electric ❑_ Plumbing Sprinklers ❑ Generator ❑ Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:e_�2koc�'
Cost of Construction: $ I Utilities: Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name h LG
Name: Ale
ry
Address: 1
Company:
City: t&Az
h state: 714�_
Zip CodecXo2DCo Fax: A/
Phone No.
Address:
City: 'w"04 /_ Stater
Zip Code: ��_& Fax:
Phone No. 7V 7� f
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail:`'�l�kl (79/n e.5
State or County LicensetW- fJr�e+�1 a'i�tf
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/E GINEER: Not Applicable
Name:
Addres :
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address
City: State:
Zip: Phone:
BONDING COMPAN _Not Applicable
Name:
Address:
City:
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 your Notice of Commencement.
_ Signature of Owner/ Lessee/Agent
STATE OF FLORID
COUNTY OF
The f r oing instr t a acknowledg efore me
this day of 20by
(Name of person acknowl dging )
(Signature of Notary Public- Stare of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
Commission No.
Notary Public State of Florida
Frances Donza
Revised 07/ 15/2014 �Of " dl Expires 07/27/2021
It S
SI&ature of Contractor/License Holder
STATE OF FLORID
COUNTY OF
The f oing ins r ent was acknowledged before me
this f day of 20 al by
(Name o person acknowledge g )
'4a CM " y �p
(Signature of Notary Pu c- f State lorida )
Personally Known -IV OR Produced Identification
Type of Identification Produced
Commission No.
Notary Public State of Florida
Frances Donza
Expires 07/27/2021
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