HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO N,U3ST BE COMPILE FOR APPLICATION TO BE ACCEPTED -
Date: � ',� I� JJ Permit Number: `lSolO
SCANNED
BY
Building Permit Applicatiorst.Lucie County
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: f_
Address:
Legal Description: JEs A rPy +Ef)
PropertyTax ID #: 07 7 I�—�OOtp 5-000—iz Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Side:
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_Mechanical
_ Electric
_ Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
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_ Gas Piping
_ Sprinklers
Left Side:
_ Shutters
_ Generator
Sq. Ft. of First Floor:
Block No.
Windows/Doors
Roof
UtilitigsSRT,ti igz ..r,.§y jqg Height:
OWNER/
NMIR
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Address gpgrQr��3�(-<f�%�'"0938_ _ a-Com
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City: /,4Az. 'q# State:C6
Zip Code: 9301 % Fax:
Phone No(,' i 7 Q ;22 I'4' 3! 16
Addresses: P 0, Pink 12
City: f'ol2-T f I ERe-01 State: -EL --
Zip Code: 346 M Fax:
Phone N `77z 33z-91oc
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail
State or County License FR*'00 151 11
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required. a/ 0 / L/ f
DESIGNER/ENGINEER:
Name:
_ Not Applicable
MORTGAGE COMPANY:
Name:
— Not Applicable
Address:
Address:
City:
Zip: Phone
State:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER:
Name:
_ Not Applicable
BONDING COMPANY:
Name:
_Not Applicable
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
SUPPLEMENTA CONST TION LIEN LAW INFOR ATION;
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
commencingwork or recordin our Notice of Commencement.
Rev.
Signature of Contractor/License Holder
Signature of Owner/ Lessee/Agent
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF �rf: I uC 1 �.
COUNTY OF I UC'
The for oing instrument was acknowledged before me
this � day
t
The for oing instr ment was acknowledged before me
+�
of �)ul'�..Q_ . 20� by
this day of .20 f Sby
(Name of person acknowledging)
(Name of person acknowledging)
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