HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ,1 ' O ^ 20 1 Permit Number:
•
Building Permit Application
Planning and Deve lopmentServices
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 /
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential V
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Descri
Praper tyTaxlD#: 1�L0 ^Cpi� ��b����� ^� Lot No.
Site Plan Name:
Project Name:
Bacl<: Right Side:
DETAILED DESCRIPTION OF WORK:
Left Side:
Block No.
��� sc-t-
CONSTRUCTION INFORMATION:
Additional work to Ie�pelrorme un ert ispermit—c ec a apply,
E1HVAC LJ Gas Tank Gas Piping Shutters Windows/Doors
Electric Plumbing Sprinklers Generator 0 Roof Roof pitch
Total Sq. Ft of Constructio I �10-- SgI�Ft.
,I of First Floor:
Cost of Construction: $ Utilities: LJSewer Septic
r.r
Building Height:
OWNER/LESSEE: �
CONTRACTOR:
Name INl WG-�i1- C';3 4J""%
Name: Q
Address: ,3 J�-r AtF, I?, Ti
Company:
City: M(WTVIVSyiLL6 State:
Zip Code: I115''f Fax:
Phone No. 'l r%""'J'�y,'y�
i-iC
Address:
%92-E
City: cc
Zip Code: 3 J
Phone No. d5b ?L:,
State:
Fax: �,
O' Ll So
E-Mail: il9 rJlui t l ei &jii iA.
I i e6✓�
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: Vo Grrmrts•
State or County License:
its 13 Lis 2 �i
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable I BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Zip: Phone:
Name:
_
Address:
City:
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 lhfay result in your paying twice for
I
mprovements to your property. A Notice of Commencement must I rr orded and posted on the jobsite
before the first inspection. If you intend to obtain financing, pponsult wi ender or an attorney before
cnmmencin2 work or recording vour Notice of Commencement.
Si at a of Owner/Lessee/Contractor as Agent for owner �i atu a of contra t/xicense noirer
S E OF FLORIDA/�(�m- _ o_ STA FL D
COUNTY OF ` LtC COU F
The fo mg instrlJ�e t was acknowledg before me The f ring instrkme�ntt wasacknowledged before me
this�dayofG�. 20by this . day of!� .20!2jby
�IYY1 I"IG��D`�iCQ.11. _
(Name of person acknowledging)
(Signature
Personally Known � OR Produced Identification
Type of Identification Produc����ypy�FNn_gnT _
C mmisslon N HH 032261
Commission No. • ' �gDAugust16,2024
;Or4f op Bwedn"Be"W"3411"
Revised 07/15/2014
�O�Srx1 �� rnm�rl
(Name of person
/acknowledging)
(Signature of Notary Public- State of Florida )
Personally Known V OR Produced Identification
Type of Identification Produced
Commission No.
Nolary PuhliG Stale of Floritla
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