HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONrt
►LL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED -3
Date: l a / )' / / / � Permit Number:
Au
Building Permit Application.... W
Planning and'DevelopmentServices
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
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Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line III
PROPOSED IMPROVEMENT LOCATION: ; III
- 7LIiitll�i7���LPa�1�UP�.>•�S'L��;f� � � � r
Legal Description:
Property Tax ID#:_3yd9-113- 000.J_ow-_s Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OFsWORK:.
(2anove of e Ig7er of `,( .vyleS, Sh,n91� fo 5-v cnMP the 1
5-u NOA: i7oaa.I
Lyga1pl 005 k0 ndet- Yarn 5-v6, i:!,
CONSTRUCTION INFORMATION: ri
itiona wor to e e orme unclert is permit - cneCK all tn apply:
�HW Gas Tank ❑Gas Piping Shutters ❑Windows/Doors
_
Electric Plumbing Sprinklers Generator Roof /Z Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 52 yOD. aO Utilities: Sewer 0 Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name O O GM Gi
Name: i -
Address: S7611 act
Company0ze'4-1G/ '66'e,
Address: 3" /57y '/ SL✓
City: _� ,pyre_ AL State: FL
Zip Cade: 3c/ isi 2 Fax:
Phone No.77Z WY2 :3qt
City: Stater
Zip Code:Fax:
Phone No.�"Z- O/a8-a38c/
E-Mail: t.C/ ✓"Lv2 7 7 ' . 46alhi
Fill in fee simple Title Holder on next page if different
from the Owner listed above)
E-Mail✓ Cho e/ ,,& -j 2 ag lyl,11h,lao
State or County License: I- C 2 902 5c/ 57
If value of construction is $Z500 or more, a RECORDED Notice of Commencement is required.
PPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ 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 inspecc� n. If you intend to obtain financing, consult wh I e itr or an attorney before
commencing workpt'jkcordins vour Notice of Commencement. /7
Signature of Owner/ Lessee/ ontractor as Agent for Owner
glignature of Contracto nse Holder
STATE OF FLORIDA �—p
STATE OF FLORIDA
FLORIDA,
COUNTY OF �S c ,st , (�.
COUNTY OF
The forgoing instr nt wasacknowledg before me
this � day of. 20 by
�j !kjct OOQxA_
The forgoing inst entwas acknowledged before me
this IL_ day of
(� 20-2_ by
\ u Chh1 �eLQ KA4 ,
Name of person making statement
Name of person making statement
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced
Produced
(`�QO
S' atu o6 Notary Public- St f EIo iLa. NA INGHAM
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Commission No. �`• Notaryt� IRil:. state of Florida
• My Comm. Expires Dec 20, 2018
o o,' Commission ;: FF 177249
(Sig ature of Notary Public- State of F r da )
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�,—�"' q� �iNA INGRAM 1
Commission No. ,.�•:,�����:"., �� Si%J,'
?a ,"� `�=: Notary Publ c -State of Florida
=• : i ^ My Comm. Expires Doc 20, 2018
Commission Y. FF 177249 I
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Rev.8/2/17