HomeMy WebLinkAboutBuilding Permit Applicationl �
ALL APPLICABLE I FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 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:
Description:
E M
i
", y
Property Tax ID #: ) (� `�� �`� �, —� 0 C 1 —10 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Re - leoa\4- w/ IA1f A) OV f W IP/ y W600 .� � i �( y' _u
S7C e x Rs din r%f 12%a ` f huyl D/ ✓t �7 Ta ur'
AUCTION
TRINFORMATION:
Additional work to e e orme under this permit —check a apply:
❑HVAC 11 Gas Tank ❑Gas Piping ❑ _ Shutters Windows/Doors
❑ Electric ElPlumbing O Sprinklers ❑ Generator ❑� Roof Roof pitch
Total Sq. Ft of Construction: Gy S . Ft. of F' t Floor: ! SG 0
Cost of Construction: $ 5"o(d V Utilities: _Sewer ❑Septic Building Height: %0
OWN ER/LESSEE:
CONTRACTOR:
Name:F6kM l to `Wtt-LI'j±1 ,V (1M �-e_d PC+n
Name:1TRA LIAVIADD
Address: DOD YWQ C419W
Company: W V
r0O60-
City: dlT�Z (. T UY State:'�JL
Address::( U °� U:)
YUU U �
Zip Code: 94CI �2 Fax:
City: OK4 J_ (1V1,D
State -EL
Phone No.
Zip Code: '
Fax: �9(a,, - — 35_0
E-Mail:
Phone No. ` o�
—
7as
Fill in fee simple Title Holder on next page (if different
E-Mail:
from the Owner listed above)
State or County License:. -
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION EN LAW INFORMATION:
DESIGNER/ENGINEER: — Not pplicable
MORTGAGE COMPANY: — Not Applicable
Name: A
Name:
Address:
Address:
City: ate
I y: State:
Zip: hone:
Zip: Phone:
!HOLDE
FEE SIMPLE TITLE _ o plicabl
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,peolsy fences, walls, signs, screen rooms and accessory uses to ano,*er non-residential use
WARNING O OWNE our fa' ure to Record a Notice of Commenc ment may
improvem nts to yo prope . A Notice of Commencement mu, t be recor
before th first ins ection.. If ou intend to obtain financing, cons It with ley
comment I; wo or recor ng your Notice of Commencement.
asPgenrfor Owner I Signature
STATE OF FLORIDA
COUNTY OF
The Ting instr ent was acknowledged before me
thisday of 20 0—by
CIS f* LV,y I -a l.r�
(Name of person acknowledging)
(Signature of Notary Pub I' State of Florida
Personally Known /-' OR Produced Identification
Type of Identification Prod"".a� '
Commission No.
Revised 07/15/2014
STATE OF FLORIDA
COUNTY OF
your paying twice for
d posted on the jo it
ran attorney _j9dre
The for oing instru ent was acknowledged before me
this day of V20 a by
SitI n.0
(Name of person acknowledging)
(Signature of Notary Public- State f Florida )
Personally Known OR Produced Identification
Type of Identification Produced
MARL.INA GODINEZ
My(%*W SION # GG1142 6 ommission No.
EXPIRES June 13, 2021
ODINEZ
# GG114236
EXPIRES June 13,
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