HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: Io� .0D)
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
Address:
Legal Description: TS lGi rik i 8 _T O _-__!jS'L— D4
PropertyTaxlD#: Lot�No.
Site Plan Name: Block No. M.SC� Project Name: \,. AQ
Setbacks Front Back: Right Side: Left Side:
❑ HVAC
11 Electric
_R-C()k&L'C VJ ��bw� +- f0l%4-Nn� A-M19S
"Shutters
F7Plumbing []Sprinklers 1-1 Generator Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ 2-0• 2-2-4i a ZS
Windows/Doors
S�Ft.j of First Floor:
Utilities: I _I Sewer 0 Septic Building Height:
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CONTRAC,TOR ,�z,
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Name C--A\CL5 VU CX —�,�-1
Address:q53� .5. oC-e y) -C W�'
Name:
Company: =CLY1Ct sm I Ite .1
Address: 35%1 INS lam' Ak r,( 4
City: j- Vr1Sen '_6e_Ct_Lh State: .
Zip Code• 5qS—:�- Fax:
Phone No.11 ' 15444
City: Epi'riCW+ State: �.
Zip Code: 5y et-g(%_( Fax."Al'a.'?S3y—iO t
Phone No. 3 34 —1 O 1
E-Mail: St'�GlG�S C"U� (2, OgmitCO.�- 1114d"'
Fill in fee simple Title Holder on next page (if different
E-Mail: A(�)14 �� & !l�LZ. .let
from the Owner listed above)
State or unty License: WY, 1811 5" 1243
If value of construction is $2500 or more, a RECORDED Notice of Commencement is requires.
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MORTGAGE COMPANY:
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_ Not Applicable
DESIGNER/ENGINEER: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City:
State:
Zip: Phone:
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.
Signature Owner/ essee ontractor as Agent for Owner
STATE FL IDA
COUNTY. o
The f r$$oing instru nt was acknowledged before me
this UL day of ILA 20 nby
I)WIA
(Namf'gf pers acknowledging)
(sign afurOf otary Public- State & Florida )
Personally Known OR Produced Identification
Type of Identification Produced _
Xr A 0-1 • L4a() 53 "19D - o
mmission No. n . ur___(Se j LASHAHNA ING
Revised 07/15/2014
s
Signa re of ontractor/License Holder
LORIDA CO F
COUNTY OF
The forgoing instru ent was acknowledged before me
this 6 — day of 20 _ by
(Nam`o e person acknowledging )
of Notary Public- StRe of Florida )
Personally Known OR Produced Identification
Type of. Identification Produced
_ J 1
RA iComriossion No.
Notary Public - State of loriva
rvnires Dec
wiy U"I" FF 17724y
Commission # Assn.
Bonded through.Nat�na NotaT- y A
L%0TIAIINA INGRAM
Notary Public - State of Florida
Commission # FF 177244 !j
Bonded through National Notary ; s
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