HomeMy WebLinkAboutBuilding Permit Applicationi�,
ALL APPLICABLE INFO MUST-BE,COMPLc 1 Ev FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECEIVED JUN 141017
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 WAS L
PROPOSED IMPROVEMENT LOCATION:
Address: k 8 -1 N e. 4IDS Id.
Legal Description: t.,n-I- 6 $-7 V h t-i- I IU"f, 01es Lt (a nr/i Y ro, i QC;4 sews V-1 7.
DOA beak Re (eE�eS ), 10 +-hw�n T Q-P rec.or,L_S IJ- Co .
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front % 4 Jf Back: S / Right Side: 0 Left Side:
DETAILED DESCRIPTION "OF WORK: L
Fro,z"-! 4- l'legr- qV`( 6-� �AnclrnJ 4 8�e/oS
CONSTRUCTION INFORMATION
Additional work to be nerformed under this permit— criec a apply:
[_1HVAC Gas Tank ❑Gas Piping _ Shutters ❑ Windows/Doors
Electric ❑ Plumbing Sprinklers Generator F]Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ d Od - G D Utilities:n Sewer[ Septic Building Height:
OWNER/.LESSEE . , ,'
CONTRACTOR: "
Name_�> "`Y�''`t—
Name: t
Company: Z G 6,t-1if�
I ' C2
Address: `) 8 iA0 Z t'�"I'h 41 a
City: N d son le State: ►v►
Address: -re 9J lill) 4/�
e e- O co
Zip Code: `I `i 4 L (0 Fax:
City: ! , -Z,
State: YC
Phone No. (n) l0 L93 -31(eo
Zip Code:9
Fax: )U 6"A/ 79(Fr
E-Mail: m 1 b o ve.rrt ED CVlgr -1e c, vt e+
Phone No.
E-Mail: c1c
d
Fill in fee simple Title Holder on nex4 t page ( if different
from the Owner listed above):.
State or County License:
d
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SU:PPLE;MENTAL=CONSTRUCTI N LIEN LAW -INFORMATION: ..
DESIGNER/ENGINEER: Not Applicable
Name:
Address:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
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
commencine work or recordine vour Notice of Commencement.
s
Signatu of Owner/Lessee/Con a or as Agent for Owner Signatur f'Contractoi/Lic6ns 5poer
STATE OF FLORA STATE OF FLORIDA
COUNTYOF L-zci, , COUNTYOF , L-yt %2
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this N_�N_ day of �5y vie , 20 Mby this _a day of 5y vvi_g , 20 AJ_by
Qy t &IN 1-e, d y C b,n ire-ri<nS4-6
(Name of person acknowledging) (Name on acknowledging)
(Signature of Notary PubliLUState of Florida) (Signature of Notary Pub c- State of Florida )
Personally Known
Type of Identification
Commission No.
Revised 07/15/2014
OR Produced Identification
MY C�� IOU # GG 022023
EXPIRES ecember 10, 2020
Bonded Thru Notary PdL Under+raters
Personally Known OR Produced Identification
Type of Identification Produced FV 9b L
Commission No.
• �c-VIYGIVJ
:s;•? COMMISSION # GG 022023
1.nrjad Thru Notary Public Underwriters
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