HomeMy WebLinkAboutBUILDING PERMIT APPLICATION,___,
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATIQIV TO BE ACCEPTED
Date: Permit Number:
N�N,
Building Permit Application
8C'BY
Planning and Development Services �L
Building and Code Regulation Division , .
st
2300 Virginia Avenue, Fort Pierce FL 34982 _ j WCL*
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial V Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: /00 O `/ (- 5 /
Legal Description: v-er 0
Property Tax ID #: 3 `i Y - S o ) _ -S '7/ -5'— O S o - i Lot No.
Site Plan Name: Block No.
Project Name: L r /3 r 2 _`1 Try X
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
itiona wor to e e orme under tispermit-checka apply:
OHVAC r] Gas Tank ❑Gas Piping _Shutters ❑ Windows/Doors
0 Electric 0 Plumbing ❑Sprinklers 0 Generator 0 Roof
Total Sq. Ft of Construction: r 7 , S S Ft. of First Floor:
Cost of Construction: $ '$4rSo Utilities:nSewer L1 Septic Building Height:
OWNER/LESSEE: it
CONTRACTOR:
Name:
Name 50 �eW "%9 V- .: 7 <0,
Address: 1000'4 05 1
Company: S 1 G (NJ C-0 %AA4'-C-Tr QQ
City: Sc w o •2 State:
Address: ) 0 Zz-" S LR L— ew l Ac_fL4 r2—A,
City: Po,Izi s1' Cuts,-e State: rL_
Zip Code: "5`kgSZ Fax:
Phone No. 5 6 1- ) S I t
Zip Code: 3 `r 4 5 Z Fax3'%70 if 0 C.
E-Mail:
Phone No. 33-) - Zf ( /
Fill in fee simple Title Holder on next page ( if different
E-Mail: S I G N
from the Owner listed above)
State or County License: 6 192 5
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
15` X) ,o x �.01. --- 6e -4 rna x 15 X 11 �6 I�}
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SUPPLEMENTAL CONSTRUCTIONLIEN LAW INFORMATION: III
Name: P-�\ ; �c ,
Address: Iu565 fS�Ltw�Y2 cr
city: QJQC sf _uc c rz State: I''Z
Zip: 7 LtK(�"( Phone: 7If5
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: rr- 4n D i n c-
Address: OO )4 Al raj rn s V
city: 5cc <- rS 642,y o-Z
Zip: Q S2L S Phone: -77 Z z.%r - 62 f
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name: _
Address:
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'Assonation 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
_ Signature of Owner/ Lessee/Agent
S
Signature of Contractor/License Holder
STATE OF FLORID STATE OF FLORID p
COUNTY OF � Luc , COUNTY OF It LUCK li
The forgoing instrument was acknowledged before me
this 21 day of IA aV 2015 by
rdw6rd L_oudel-back
(Name of person acknowledging)
(LU
(Si ature of Notary Pu lic- State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
Commission Noj UUKRISONA L LOL
S.'.MYCOMMISSION
Revised 07/15/2014
The forgoing instrument was acknowledged before me
this day of M ay 20 L5 by
E-�wQrd 1110.6 rJl1'L--
(Name of person acknowledging)
- zotad)a cj(—
(Sig ture of Notary Pub ic- Sta a of Florida )
Personally Known V OR Produced Identification
Type of Identification Produced
MY COMMISSION #F
EXPIRES August 7.
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