HomeMy WebLinkAboutBuilding Permit ApplicationALL -APPLICABLE INFO MUST BE COMP IETEU FOR APPLICATION TO BE ACCEPTED -'
Date: (S[1 4o1 -Permit Number:
RECEIVEED JUN 16 2017
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 �O0
PROPOSED IMPROVEMENT LOCATION:
Address: 5
Legal Description:
Property Tax ID #: q 000—
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
old lalled
U �
Lot No.
Block No.
CONSTRUCTION INFORMATION:
Additional work to be rtormed under is permit—c ec a app y:
�HVAC Gas Tank ' _ Gas Piping _ Shutters W' doves/Doors
Electric Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction: $ ZO&S b� UtilitiestSewer Septic . Building Height: /off f
OWNERAESSEE:
CONTRACTOR:
Name _le,16
Name:.
Address:WL95(
Company:
ciL
City,,--- �.d,(C.� P State:{`
Address:
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Zip Code:,,54 0 Fax:`
City: ` G1,1/"IL
State: F
c—�
Phone No.
Zip Code: _-3L(qq__1
Phone No.
E-Mail:,
Fax-t72,82 774
C-2 CCQ(.2r r5 - C
E-Mail:,-
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County L
nse: CCC «=2h15? Li
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTR ION 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 coveriants 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 recordinl? vour Notice of Commencement.
_ Signature of Owner[Lessee/Agent
STATE OF FLORIDA
,
COUNTY OF I'ffflll
The forgoing instrument was acknowledged before me
this Jr-D day of 20 aby
Ira I ya /kppa v;
(Name of person acknowledging) :.
(Sign ure of Notary Public- Stakk of lorida )
Personally Known OR Produced Identification
Type of Identification Produced
Commission No.I=
�`"°` `IIEB (I RESTIFO
W� MY COMMISSION # 0091663
1�z -I s
Signature of Con actor/License Holder
STATE OF RID
COUNTY OF RID rl
The K
ing instru ent was acknowledged before me
this dayof Ut l C , 20 _II by
� l
e o (Namf a son acknowledging)
(Signatu a of Notary Public- ate FI ida
Personally Known OR Produce Udeification
Type of Identification Produced -
Commission, No. Qi' 3 (Seal)
REBECCq
REGa 0 Revised 07/15/2014�aR �X OMMISSION#GG91863
21
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