HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABL4 INFO M 5 ff BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: t Permit Number: _
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:
0
a �. �- • 3 �f a `l.�
Legal Description: L r'�j,, !�� Z Ir' r!f 1'�1�T -r �6 z
Go f 5 .Z , 1 ��1 -6, /7, 8 73Lic- /Y
Property Tax ID #: (b r1®l2 ��®� Lot No.
Site Plan Name: Block No.
Project Name: - �� T� CV
Setbacks Front_ Back: Right Side: Left Side:
-------- 7,71
DETAILED DESCRIPTION OF WORK
CONSTRUCTION INFORMATION:
Additional wor to e e orme under this permit— cl
[1HVAC [. Gas Tank ❑Gas Piping
Electric ❑ Plumbing Sprinklers
?ck all tha app v.
L_! Shutters
❑ Generator
Windows/Doors
Roof
Total Sq. Ft of Construction: , 2Z o S Ft. of First Floor:
Cost of Construction: $ 3> �° a Utilities. Sewer E]Septic Building Height:
OWNER/LESSEE:._._ ,_x , _ _ _ w, :.w ._ p
-CONTRACTOR-."
Name t,:4t 'e S LLB
Address: (16 kA U011*�
City: `l-rt State: Et-
Zip Code: 3 qq '7�! Fax:
Phone No. FM
E-Mail: ("_ S,a V eA (A) �AtN e4 6A44
Name: •-b rJ ot-t
Company: —tQ L c-btrri-Sz-
Address: Vt7 0'0 Aet'-st", 4J
City:( Stater
Zip Code: l 13 Fax: l Jk
Phone No. 7 - O 16.6
Fill in fee simple Title Holder on next page ( if different
E-Mail: S H , LOR-t C�A
from the Owner listed above)
State or County License:
If value of construction is $2500 or more, a RECORDED Notice or Lommencemem : is requires.
SUPPLEMENTAL CONSTRUCT LIEN LAW`INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
BONDING COMPANY: —'Not Applicable
Name:
Address:
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 vour Notice of Commencement. 17
_ Signature of OwJnn r/ Ossee/Agent
STATE OF FLORIDA I a STATE OF
COUNTY OF ::SA bi CLZ I COUNTPY-I
The forgoing instrument was acknowledged before me me
this day of C CLAA 20 i7 by this
instrument was acknowledged before me
of �(�( (n 20 ;ncy
(Name of person acknowledging) (Name of person acknowledging)
(Signature of'Notary Public- State of Florida )
Personally Known OR Produced Identification I Personally
Type of Identification Produced Type of Idj
Commission No.
Revised 07/15/2014
Notary Public State of
My commission rr
Expires 12/OB/2019
Florida
OR Produced Identification
Notary Public - State o�gl g y
�COrnualssl n # FF 234730
My Comm. Expires May 27.2019
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