HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 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
Mechanical _ Gas Tank Gas Piping
_ Electric _ Plumbing — Sprinklers
Total Sq. Ft of Construction: 3_
a,
Cost of Construction: $
Shutters
Generator
Sq. Ft. of First Floor: —
Utilities: ,Sewer Septic
Name 3'1 b V� +- T)6 R'4 r �- e_ C
Address: NA � G " " LE
City: P� , ' �- vG State: �-
Zip Code: 3 Lf�Fax:
Phone No. -
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Windows/Doors
Roof Pitch
Building Height: --
2
Company: 14ryi a C'C'LlCsr &I/#' IX VM f'✓t(�-
Address: 160.3 V4 Ile- tj
City: RcVf State:_
Zip Code: Fax:
Phone No 6,
E-Mail
State or Cou y License ll �1
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address: State;
City: phone
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Z' R
MORTGAGE COMPANY: __ _ Not Applicable
Name:
Address: State:
Zip: e:
COMPANY: Not Applicable
Name:,
Address:
Zip. Phone:,
ip.
OWNERJ NTRACTOR AFFIDVIT: Application i h to y issuance of i pepe unit to do the wrork and installation as indicated.
I certify that no work or installation has commenced t.
p p
n applicable Nome Owners AssocEa#ion rules, bylaws or and covenants that may restrict or prohibit such
St. Lucie Coun make no representation that is granting a permit will authorize the permit holder to build the subject strut ure
which is in conflict with y pp
structure- Please consult with your Nome Owners Association and review Your deed for any restrictianerfar the womay rk
apply
-
structure. consideration of the the approved plof ans, sreq Florida Building (ding Codes d p and St Lucie Couit, I do hereby agree that I knty Amend metntsp
in accordance we Pp
The following building permit applications are exempt from undergoing a full concu ory us review: rooer m addrti non-residential
accessory structures, swimming pools, fences, walls, signs, screen rooms and access
ilure to Record a Notice of Commencement uses
Ito anothi1 your paYlng Ice for
WARNING TO OWNER: Your fa
improvements to your property. A Notice of Commence ngn QnsSt b ith le der or an attorney y befooresite
before the first inspection. if you intend to obtain
commegeft WO k or recordin our N tice Commencemen . `- Z'y
Signature of Owner/ Lessee/Contractor as Agent for Owner
STATE OF FLORIDA L—LA C-- C-
COUNTY of
The forgoing instrument was acknowledged before me
this I Lg day of . , mac' 2D by
�r6,vLG1
(Name of person acknowledging)
(Signature of Notary Public- State of Florida )
Personally Known _A.Z—
Type of identification
Produced
Commission No.
Produced Identification
2°<Payey i CHARLOTTE M. WALTERS
mission # GG 921080
-rQ = Expi s hlggeml?er 24, 2023
FGr'r.4•` Band sky Fain 1nsurance800-3$5 70
REVIEWS
FRONT
ZONING
SUPERVISOR
COUNTER.
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
re of Contractor/License
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this J, day of ��s-i- 20 : ii by `•
(Name of person acknowledging) '
C I
(Signature of Notary Public- State of Florida ]
Personally Known ✓ OR Produced Identification
Tvne of identification
, c. M. WALTERS
Commisson G,,9�j1080
No. "' `-` xpires itiove�F'14, 2023
8ondedThmTroy Fain Insurance $Oil-385-7019
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KING CARTER ALUMINUM
1603 EDGEVALE ROAD
FORT FIERCE, FLORIDA- 34982
772-461-5369