HomeMy WebLinkAboutpermit applicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 01 W 0 W !20*12i Permit Number:
Building Permit Application
Planning and Development5ervices
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fox: (772) 462-1578 Commercial Residential,
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED, IMPROVEMENT LOCATION: r
Address: !&SO[n �S OG[Q..10(o Trgn Seack t T�- 34157
B
Legal Description: L' 1(\u TS1ond p_UD6 1 tt' Or 17 �7O(02
Property
Site Plan Name: Block No.
Project Name: Zn:;G1 S�lo►c1&5
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
1 Qce L( %Aind0V4 t `7 door O(kriq
CONSTRUCTION INFORMATION
Additional work to be ertormed under this permit —check all apply:
�HVAC Gas Tank �GasPiping _Shutters Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Constructiodn: S Ft. of First Floor:
rV
Cost of Construction: $ 013 33 AID /� Utilities:[]Sewer OSeptic Building Height:
OWNE.R�/LESSEE:
CONTRACTOR:
NameihS�O� 1�
Name:�5'Q'S(�h �Il
Address: 544S0 `S 0Lft1\ '7UO
Company:V4%1N& kwi'(—LDO(
City: 7FeAVAN 9plipinic State:'
Zip Code: 5 Fax:
Phone No. ' i08'1)(prol
_1
Address: iter NnL IJY
. gs+ae • IS
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City: V TU #+tr
Zip Code: 11q S Fax:
PhoneNo.o.!Srot- 3^K$—Ltr&!7
State: ��—
E-Mail:
F
orN011 OA 00-12o Cz@\
Fill in fee simple Title Holder on next page( if different
from the Owner listed above)
E-Mail: 1 i W A otna
M •
State or County License: S uL V ,3 15
U Z 3
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
IGNER/ENGINEER:
Name:
Address:
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 COMPANY:
Name:
Address:
Zip: Phone:
_Not Applicable
certify that no work or installation has commpnced prior to the issuance of a permit..
St. LucieCounty makes no representatloh'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 tfather non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement mayren your paying twice for
improvements to you property. A Notice of Commencement must be recorded posted on the jobsite
beforethefirst in tion,)£yoTri iT�tend to obtain financing, onsult with lendan attorney before
as Agent for Owner
STATE OF FLORIDA
COUNTY OF $f• GULff
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this23
day
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(Name of person acknowledging)
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(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification Prop It Wit I IAMLCLOVER
* * Commission#GG343336
Commission No. Exii&Ad%2023
'1147tpeP eondad mN Budget Notary Servkee;
Revised 07/15/20,14
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The forgoing instrument was acknowledged before me
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(Name of person acknowledging )
(Signature of Notary Public- State of Florida )
Personally Known V/OR Produced Identification
Type of Identification Produced
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