HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 "� 1 Permit Number:
R E C E D AUG 0 31017
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: -1 100 Se 6kS•ric,^ Pir•llce, FI 34A6'1
Legal Description: 1.aU (gs-7 Ibloak IV Pa,,-IG (.In.i_ 1 I
QI�k booK 'S ;L •
PropertyTax ID #: 1301-613 -o'3pS -UOc� ^"� Lot No. CO-1
Site Plan Name: Block No. ISO
Project Name:
Setbacks Front�G Back a•5 Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
by i I rr.S w )'. r.1.^-5 Poo k
CONSTRUCTION INFORMATION:
Additional work to a er formedunder tis permit -checka apply:
11HVAC Gas Tank Gas Piping In Shutters Q Windows/Doors
0 Electric EPlumbing O Sprinklers E Generator E]Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $
S Ft. of First Floor: _
Utilities:OSewer F Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name So a y Po\\an A
Name: Ron S:\\S
Address: - %00
Company: Prem,erc 960\5, anti SaaS
City: Fbr-�- Pierce Stater
Zip Code: 34g57\ Fax:
Phone No. -72'I - 53LA- %41 c1
Address: Sorg TrI
City: Deer-c.'C_0 3eac\n State: F1
Zip Code: '��L4H a Fax:
Phone No. Q 5 y - 6'31-070-1
E-Mail:y Po��nna fir" �9d1. C1�rh
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: rs;�\s �Toas.wr►,
State or County License: CPC. Ili S tS99S
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SURPLEIVIENTAL CONST,RU,CTION LIEN LAW IINFQRMATION:
- - - - -
DESIGNER/ENGINEER: _ Not Applicable
Name: whunt 'at nn6�4
Address: 26S S g iog
City: ocGc►J State:
Zip: '1,3HN t Phone: q54 - `s 11- 3 ir,2
FEE SIMPLE TITLE HOLDER:
Name:
Address:
Citv:
Zip: Phone: _
J 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.
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 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 inteno4b obtain financing, co ult ter h lender or an attorney before
commencing work or recording your otce of Commencement. I
Contractor/License Ho
STATE OF FLORI " STATE OF FLORIQA-
COUNTY OF,C.�� COUNTY OF
T fo ing instru ent w acknowledg efore me
thi s
o 20VJ by
571a7e of person a knawledging(I')
(Signature of Notary Public- State of Florida )
Personally Known _
Type of Identification
Commission No.
Revised 07/15/2014
OR Produ
T"orgins ument as acknowled ed before me
of 20� by
(Name of person acknowyledgi�ng..)`
(Signature of Notary P lic- State of Florida )�
tion Personally Known OR Produced Identification
Type of Identification Pr% qqd nwam L Stead
NOTARY PUBLIC AXINOTARY PUB,}yIC
STATE OF � GRIDA Commission No. STATE ORIDA
Cantu# Q0010408 Comm# QO010405
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