HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE LUMPLETED FOR APPLICATION TO BE ACCEe i W
Date:
Permit Number: Cly` _-03q 1
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 liner
I PROPOSED IMPROVEMENT LOCATION: I
Address:
Legal Description:
Property Tax i[
Site Plan Name
Project Name:
Setbacks Front
-()nilF6R hk.(o-7 L6
Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
itiona wor to e e orme under this permit —check all that. apply:
�HVAC Gas Tank ❑Gas Piping Shutters Windows/Doors
Electric 0 Plumbing ESprinklers 13 Generator Roof
Total Sq. Ft of Construction: dr — —1 S . Ft. of First Floor:
Cost of Construction: $ Igrnno 10 Utilities: Sewer ESeptic
Building Height: 212
f
OWNER/LESSEE:
CONTRACTOR:
Namechr5 r
Name:
Address: CA 1 r-
Company:
kXC
City: Ief2_li State: _
Zip Code: Z-c q&2— Fax:
Phone No. 3(_01 212M
Address:
City:
Zip Code:
Phone No. —7-7Q ;23--?
(Q
State:
Fax:'719 fig-? -7--2 6�
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: C
✓ ( r5 . COIF(
State or Count icense: (-CC
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRI ON 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:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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
WA�ROING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
mp ovements 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
co mencing work or inspection'vour Notice of Commencement.
FLORIDA
OF /(/(, iaf4in
The forgoing instrurpent was acknowledged before me
this _-2� day of 20 .�by
/�Z_' "� s
Signat a of Cont act r/License Holder
STATE OF FL. DA
COUNTY OF M2Lr-- n
The forgoing instrument �was l �acknowledged before me
this day ofY.l 20 1-1 by
or (a-ft--Douce (as F_ &e
(Na a of person acknowledging) (Name of rson acknowledging)
(Signat re of Notary Public- S to o Florida) (Signs)ure of Notary Publi St to of Florida )
Personally Known OR Pro uced Iden ification� Personally Known Produced Identification
Type of Identification Produced 7 T Type of Identification Produced
Commission No. Q (Seal) Commission No.0q l$703 (Seal)
REBECCA RESTIFO IftE�'13bt-11 1t nL17.
' "Revised07/1/ }MY COMMISSION #G091863 MY CWMISSION18630417,202y21
aF�o� EXPIRES: May 1
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