HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE IN O MLIST BBE/CGi`yrtETED FOR APPLICATION TO BE ACCEPTI
Date: I f a] I" Permit Number: t7
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
PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description:
1 Lo,'- lv-( %6
--7
PropertyTaxlD#Lot No.
T7
Site Plan Name: r l�T� luo4uf Block No.
Project Name: _
Setbacks Front
Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
hem ve roof ra4-ev-i c( -(6 CUCL) r(-Ivo� --6 cc . I h54e ( ( Sel-�'
Seri l,��1C�C ✓lei v�v� f'�-QuJ c 46U �4- [OS46-- 0 rut �PA.� -06_4 ��
13
q n_cw vek-lis . 3/ ( �� l
CONSTRUCTION INFORMATION:
Additional workto e e orme under this permit — check a apply:
[]HVAC E] Gas Tank HGas Piping OGenerator
Shutters Windows/Doors
OElectric 11 Plumbing Sprinklers aRoof
Total Sq. Ft of Construction:
Cost of Construction: $ �`'� P 6G
S Ft. of First Floor: _
Utilities:Sewer[]Septic
i
Building Height: 15
OWNER/LESSEE:
CONTRACTOR:
Name !/ ur
Name:
QS
Address: 1iUo� r_txf 1 i-
Company:
City: a�LI" Stater_
Zip Code: JqqS P Fax:
Phone No. —7% _75(&25
Address: �Sl_ S/0_4V Sf
City: S-(Lnpl_f Stater
Zip Code: - J -1 Fax:-77a 282 "%7 0
E-Mail:
Fill in fee simple Title Holder on next page ( if different
Phone No. %�o
cP� �2R
E-Mail: � C R-irCL)(!G(i`,d
dt-C) C 6w
from the Owner listed above)
State or County License: CC C
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUC , LIEN LAW INFORMATION.
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ 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 your Notice of Commencement.
,'K yz"t.:� X.
_ Signature of Owner/ Lessee/Agent
s
Signaf&6 of contrac r/License Holder
STATE OF FLORIDA , STATE OF FLORIDA
COUNTY OF Mc r+rl COUNTY OF A (LF-60
The forgoing instrum nt was acknowledged before me
this � day of C� • 20 Lby
SIkI.P-a0 AUSGJr'
(Name of person acknowledging)
(Signature of Notary Public- St)te o FI rida )
Personally Known OR Produced Identification\
Type of Identification Produced —�L_
Commission No. (315,a ( KV5
RESTIFO
MY CGMMIss►vw ff ---•--
Revised 07/ 4 EX'�'" 17,2921
O,
The forgoing instrument was aFk,,n,/o'wledged before me
this � day of 4)9VJ?_(MJXV , 20 t7 by
S
(Name of peon acknowledging)
(Signala of Notary Public- State of FI)ri
�j
Personally Known OR Produced Identification
Type of Identification Produced
Commission No. 3 . (Seal)
EXPI "i�a�1UN # GG91863
vvv% S_ A4ay 17, 2021
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