HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
J RECEIVED AUG 02 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: Renovation
P
PROPOSED IMPROVEMENT 'A W,
Address:
Legal De
Property Tax lD#: 'JN",)
Site Plan Name:
Project Name:
Setbacks Front Back:
MWOO&W,
ire, I �,
9- Y'r, -C 11271 Y, 3 t-1
Right Side: Left Side:
0-f wall ftnAfjqo,� Df I vioO I -, nt Cta��
�- 4) q � \% 0,(1 ) Y-\ S � � � t 0_V%
1 15-4
2, �
Block No
II
EjHVAC EJGas Tank EJGas Piping 1-1 Shutters F]Windows/Doors
11 Electric El Plumbing RSprinklers MiSenerator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ aV) _ Utilities: E]Sewer E]Septic Building Height:
OWNER/LESSEE
Name ,e_Av\, Ills
Name:
Company:
Address:
Address:
City: C-0,c V, I Q. V State: rC
City: State:
Zip Cocle:3'i� � 5 — Fax:
Phone No. 7 -72- - �4 1 '75-7 1
Zip Code: Fax:
E-Mail: nicbry\
Phone No.
Fill in fee simple Title Holder on ne4age (if different
E-Mail:
from the Owner listed above)
State or County License:
I If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL'`CONSTRUCTION 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 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.
as
STATE OFTLORIDA
COUNTY OF 4a_ LJc �Q
The forgoing instrument was acknowledged before me
this '4, day of 20 Aby
s
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this _ day of
(Name of persona nowledging) (Name of person acknowledging)
Notary Public- State of Florida )
20 _ by
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced fi t- L Type of Identification Produced
Commission No. - mmission No. (Seal)
aYo� CEA NAMARIEGIVENS
_ �`� MY COMF4lsS10N # GG 022023
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Revised 07/15/201 ' sOjr Bonded NotaN -----Underwriters
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