HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: S 11C-k l l 0 11 SGAt4NED Permit Number:
W
Stude
B'uilding Permit Application
Planning and Development Services i ���e��®� 070J®
Building and Code Regulation Division <4, ®,a®
2300 Virginia Avenue, Fort Pierce FL 34982 ` ck;, I?)
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address: / (<710 Q-Ge, a a Avg
Legal Description: 9 1?!j Z 1i�l�.l;-
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roperty'Tdx ID #: 7-soci �2 ?,3 - C?IC�c'� i Obo -
Site Plan Name: K 'Ia4dC� 17
Project Name:.
Setbacks Front Back: I Right Side:
(I R
1 A/
Lot No.
Block No.
Left Side:
•� ts�S • Ob 2`�
A
r ,. i i7,,,r A2 A " :!D 64 C.n, C Dn c ucs77'. &-W e-
Additional worK to be pertormed under tnis permit- cnecK all mat apply:
_Mechanical _ Gas Tank - Gas Piping _ Shutters _ Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
_ l
Cost of Construction: $
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic
Building Height:
OWNERJ
FeONTRACTOI R:
Name U
Name:
Address: (17 I0 r�z�"i
Company: LL
i
City: Q '�� State: �'�
Zip Code:`fiCl&(Fax
Phone No. 7� �?�7h �
Address: �4e (-t r2L vac c—c r,L1 c 1) !� _
City: F3 , C Stater
Zip Code:d� tf Fax:
Phone No ? 7Z - 32l Z 6,
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)+
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E-Mail 61K- try Pe,9 cc 61A 6, r 1- c'�•�^
State or County License
If value of construction is 2500 or;more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTIONI LIEN LAW I'N
ORMATION:
DESIGNER/ENGINEER: _ Not Applicable ¢'i��IVfO.RTGAGE
-Name:'Name:
COMPANY: Not Applicable
-
Address:?i�f sa��`"•
City: State:
' Add.ress'
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:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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 your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signature,of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF rS
COUNTY OF�!f,)r,"cA-4Z,
The forgoing instrument was acknowledge before me
The forgoing instrument was acknowledgeq before me
this day of by
this day of 20A4 by
G-Irk
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary blic- State of Florida)
(Signature of Notary Pu ic- State of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identifica '
Type of Identification
Produced 'irl QL—
Type of Identification pEy�F1NAMARIEGNENS
ced ' C pL si:?Y"'•.. sskoN#GG02201
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pEANNAMARIE
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Commission No.�5��:�P "Y° U
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REVIEW
DATE
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RECEIVED
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