HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLE i tv FOR APPLICATION TO BE ACCEPTED
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Date: ,V )' a�-17 Permit Number: �' lUJ
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 a
PERMIT APPLICATION FOR:
PM 4PM& D',�AIN � AWIQ E T L®CATIQN:
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Address: O � e!Ie 1 ✓&/
Legal Description:
Property Tax ID #: 1 3� 1 • d� • ��J� • non Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DE=�SCR?IPTIO/N OF V110RK9:
C®NSTR+UCTIQN I�NFO'R�MATION:
3
Additional work to be per orme under this permit -check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator Roof Pitch
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Total Sq. Ft of Construction:n Sq. Ft. of First Floor: co
Cost of Construction: $ Utilities: —Sewer _Septic Building Height:
O1hCN ER%LESSEE:
CONTRACTOR:
Name:.
Name f .
Address: ' 0
Company:
City: P�. (4- State: -FL
Address:
City: State:
Zip Code: 3 Fax:
Phone No. 77a G - b ��
Zip Code: Fax:
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E-Mail: �61✓`�i/G1 `VP�( Vile-, O . w?4'J
Phone No
Fill in fee simple Title Holder on next page ( if different
E-Mail
from the Owner listed above)
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
L
ENTA CC?NSTR�UCTION LI' , LAW lN'FORMATIOON'
SUPPLEM001
DESIGNER ENGINEER: _ Not Applicable
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MORTGAGE COMPANY: Not Applicable
Name: "( We r� Zi ec-
_
Name:
Address: (124 S.W. L 14- morf Sf
Address:
City: _�c r{_ ��;,,� (,,,;� State: FL
City: State:
Zip: �gziPot Phone i7)- 72�-- g P&�—
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
—
BONDING COMPANY: Not Applicable
Name: lel E:
Name:
Address: ,(o
Address:
City: rO,rene,
City:
Zip: Phone:
Zip: Phone: 77) - OP 09o2S-
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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 anbther 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 our Notice of Commencement.
Sigtfaiture of O er/ Lessee/Contractor as Agent for Owner
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF�4 .61�,
COUNTY OF
The forgoing instru a was acknowled ed before me
day
The forgoing instrument was acknowledged before me
thi _ of 20by
this day of 20_ by
(Name of person acknowled g)
(Name of person acknowledging )
q!ipfiajure of Notary Public- ate of Florida)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
(jo •
Produced
Commission No. 1 �„ LASh(S'e'a
Commission No. (Seal)
Notary Public - state of Florida
Dec 20. 2018
M comm. Expires
N.° r'•'-' 'o
'�1VONIINhNati
commission
FF 17 249
REVIEWS
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REVIEW
REVIEW
REVIEW
REVIEW
DATE
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RECEIVED
DATE
COMPLETED
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ev. 7/2014