HomeMy WebLinkAboutBuilding Permit ApplicationALL -APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Building Permit Application
Planning and Development Services t,9 0
Building and Code Regulation'Division Q_/
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 4624553 'Fax: (7.72) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at,the. end of line
PROPOSED IMPROVEMENT LOCATION
Address: C -LA M-Rm \LS U ` ` RAN Qs\
Legal Description:\JeM-kes-7�.S\-ark
Property Tax ID #: y�=,02 - 5l�\, �O`\`\ - L��O-\ Lot No.a AIA
Site.PlanName: Block No.
Project Name:'
Setbacks . Front \O Back: Right Side: Left Side:
DETAILED DESCRIPTION OFWORK:
Re \RCeC\eil\_ 01V .MQ`Q���
CONSTRUCTION INFORMATION;
A .clitional work to . e. e.rtorme - un _ er. t, is permit - check all that app y:.
HVA Gas ank El
Gas Piping _ Shutters. �VmOows/Do0..rs.
_ Electric _Plumbing ElSprinkle.rs El Generator 0 Roof
Total Sq. Ft of Construction: 3��,Z�5 .� S . Ft. of First Floor:
Cost of Construction: $ Utilities: Sewe r El Septic Building He
OWNERAESSEE:
CONTRACTOR:
Name C��r at\ot c�
Name: es1d �g_
Address:c`�1�2i:`\%_\
Company:
City. e51�e5 %RSP � State'
Address���1`�i S\il
Zip Code:3���� Fax:
City�A\ AVII State.L
Phone No..
Zip Code:fax:
E-Mail:
Phone No.`1�a
Fill in fee simple Title. Holder on next page (if different
E-Mail:
from the. Owner listed above):
State or County License: C 91:3
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: Ip V c, <- State_:` L City: State:
Zip5k I6_,P-x5 Phone: 0= .ice Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: 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 vour Notice of Commencement.
1�� U'D 1LLL____jA k)
Sig ture of Owner/ Agent/ Lessee Silrrdture of Contractor/License Holder
STATE OF FLORIDATATE OF FLORIDA
COUNTYOF COUNTY OF
The r oing instr ent was acknowledged before me The forgoing instrument was acknowledged before me
this day of v 20 14 by this day of u 2014 by
(Name of person acknowledging )
(Signature of_Notay..,P.ublic- Sta of,F10
jLL[h r. HUNTER
Personally nawrt, OR Pftuce&WerofiFioetl'�
Type of.lde tifi4a n� rb6bcrednm. LAImes Jan 23, 201E
F ,,
Commissio No. 9h Natio(r9i�l)' Commission EE 31T,7.&
" Bonded Throu Assn
Revised 07/15/2014
(Name of person acknowledging)
(Signature of Notary• sir- Sete of Florida" )
Personally KnowPrQA6�Anit IR .
a e or rforw
Type of Identificatrona.Pr,; eddy romm
Commissippn #FFf
Commission No. + Bonded Throughl5,+al)
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