HomeMy WebLinkAboutBuilding Permit Application'-
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �01�T�T_ Permit Number:
RECEII,77-D JUN 12 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 _X Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line b �30 p 5
Address: T6;bTS . d c_-e_& l bC . 1 YIS�I(i� 21J�[ �/1 P. -
Legal Description: 15L CL CNA Na I 0 (i1 AD - UA l 1SOq1
Property Tax ID #: 45-p2 - (op 1- O 1-13 - oo p - I Lot1Vo 10 aleg
Site Plan Name:
Block No.
Project Name: _.L.S� a YO-1 ai I
Setbacks Front Back: Right Side: Left Side:
11HVAC
FlElectric
'a,\� � kas5 doo v-s
m
i ,_om C+ C.C)OI?S
_ L_I Shutters
0 Plumbing Sprinklers Generator Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ (, 1 V5`l . to
Sq. Ft. of First Floor: _
Utilities:Fj Sewer Septic
Name �1!L- l tt' rR")
Address: I_.,1!1mef n1 L6..'
City: , acme, c- i- 4115 State: N
Zip Code: 1441 a— Fax:
Phone No. 4 S- I SO - '53 zi
E-Mail: 5 CC+J-0 Q. 1�lC�fld�f�$� l Sri uc
Fill in fee simple Title Holder on next page ( if
from the Owner listed above)
Name:
Company:
Address:
Windows/Doors
Roof
Building Height:
City: _ 6 U-z, r4- State: T:;L-
Zip Code: 3'4'J'j L4 Fax.1-10 -33y -1011E
Phone No. c')L - L4 - 110 1
E-Mail: t
State or my License: 5CC 13 l 1 S 12 �3
1
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: - , ,
Name: _
Address:
City:
Zip:
Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: _
Not Applicable
MORTGAGE COMPANY: = Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
Not Applicable
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 eoncurrency 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.
ner/Lessee/Contractor as Agent for Owner
STATE -OF FLO IDA
COUNTY OFF.
The forgoing instrument was acknowledged before me
thisl'Z,day of 20U—by
/,-- �el'l Cel�. ' s
Signature of ntractor/License Holder
STATE OF FLORIDA
COUNTY OF SA,
The forgoing instrument was acknowledged before me
this `O-day of 5 0 T\-g 20 E by
5s 0, -N .-N 'M -\ C__ \ I 5
(Name of person acknowledging) (Name of person acknowledging )
(Signature of Notary Pub`tit- State of Florida )
Personally. Known OR Produced Identification
Type of Identification Produced T 1— ID 1L—
Commission No.
Revised 07/1
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification rt E102a..- V Zt—
p�q'��!�Mf RIE Gfv cIJS' '?' MY COMMIS N G'022023
MY Col�liNf:iSfoN # Go 022023 Commission No. �. EXPIRES; D ;16, 2020
EXPIRES: December 16, 2020 '':FodFL�p' Bonded Thru NotaryPublIc Unde'
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