HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number: L I fty - 04Sa
Building Permit Application RECEIVED
Planning and Development Services JUN 2 d 2017
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 PER f fNta
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Resideistiahci o L
PERMIT APPLICATION FOR: Gas piping
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PROPOSED' I,IUIPRO,UEIVIEpNT�LOCATION;'',
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Address
Legal Description:' �J�Y
PropertyTax ID #: t*_�-� \•'3� Lot No.
Site Plan Name: �CA��T Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
❑ HVAC
❑ Electric
_k �`� �-. % u� �C Liz)
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0 Plumbing
Sprinklers
Generator
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❑ Windows/Doors
Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ "NS °cU Utilities: _ Sewer ❑ Septic Building Height:
OV1/NER/LESSEEy �,j 2, �,7Tn
CO RACE a Rti r
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Name waltC; m 1%Gl,� e't:1'
Name: (l.
Addres u-rW 1(W—ijSY'1 (sty—
Company: nnnn
Address: SZ _Q)-, YJQ iI��
City: wt.� G�-K/ State:
Zip Coder 4 b Fax:
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City: F9 w� mote StateC: F r1
Phone No. m- 3 l.p <I ��
Zip Code: � t�� Fax: ' 31 p"�C�9
E-Mail:
Phone No. 3L�Lkb
E-Mail: a U e cneff4gM
Fill in fee simple Title Holder on next page ( if different
State or County License: K— t4,--i
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
Not Applicable
BONDING COMPANY:
Name: _
Address:
City:_
Zip:
I certify that no work or installation has commenced prior to the issuance of a permit.
Phone:
Not 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 intend to obtain financing, consult with lender or an attorney before
commencl0moA or recording vour Notice of Commencement. 110, _.-
re
as Agent for Owner
nse
STATE OF FLORID + STATE OF FLORIDA
COUNTY OF �, n- _ COUNTY OF
The f going instr ent wa acknowled a before me
this day of 2 by
Personally Known
Type of Identifical
Commission No. a Notary PM LsA to of Florida
Antonia Pq la
eS n My Commission FF 191201
Revised 07/1
The forgoing instrument was acknowledged before me
this tL day of .1 A ,if. � , 20 A_7 by
(Name gfji erson acknowledging)
(Signature of Notary Pu 'c- State of FI ida )
Personally Known OR Produced Identification
Type of Identification Produced
- T 'r T T T T T T T O -- -
Commission No. w Not ry Public State of Florida
Antonia M Paula
Expires 02127/2019
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