HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APP ICABLE INFO ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I r� I
Date: Permit Number: 1l�
Building Permit Application Munooel�q aS
Planning and Development Services r-►�r A8
Building and Code Regulation Division 03NIYV/0S
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 line
PROPOSED IMPROVEMENT LOCATION: f
Address: 5 US—/r//GA1P//G/c !", eV1/r /FUl ��T. //�'/ICdL 67%s/
Legal Description: 5`G � 7�QP
Property Tax ID#: /,I/7/,ZIZJ, -00,00 QDJ-7 Lot No.
Site Plan Name: L V4 6/ v L Block No.
Project Name: zz vlwof_
i
Setbacks Front Back: Right Side: Left Side:
DETAILED QESCtIPTION OF vuORK , d"
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CONSTRUCTICININFORMATION':
rtiona wor to e e orme un ert ispermit—c ec a appy:
❑HVAC Gas Tank ❑Gas Piping _Shutters ❑ Window Doors
❑Electric ❑ Plumbing []Sprinklers ❑ Generator ❑ Roof
Total Sq. Ft of Construction:
Cost of Construction: $ 02- no
Sq��Ft.I of First Floor: _
Utilities: Ft of
Building Height:
OWNER%LESSEE ;`;
CONTRACTOR:
Address: <-a/o�uh�%«� f crwfy )OW,
Company: f jo
City: �f / n eAc& State:/
Zip Code: 3Y*-i I Fax:
Phone No.2 5%�n J� / / fj i
Address: f/9Od :r�J, /a ZVI
City: pu?/Icf_ State:
Zip Code: S Fax:
Phone No. Z 5
E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
_
E-Mail: l il(i V f ��/ay FGoo Ltl fN /�/1riP
State or County License: Z 5-3 1,9 A,
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
I,ofe-
UPP, EMEt TAL GONSTRUCTfON UEN LAW, INFORMATIONt"
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DESIGNER/ENGINEER:
Name: 94AV
_ Not Applicable
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MORTGAGE COMPANY: _
Name:
Not Applicable
Address: iv
iD
Address:
City: a
Zip: 3 22y y_ Phone:
State: -Z5�-
7 Z— Z O S`S L
City:
Zip: Phone:
State:
FEE SIMPLE TITLEHOLDER:
Name:
_ Not Applicable
BONDING COMPANY: _Not
Name:
Applicable
Address:
Address:
City:
City:
Zip: Phone:
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
WARNING TO OWNER: Your failure to Record a Notice of Commencement r y result in your paying twice for
improvements to r property. A Notice of Commencement must be re orded and posted on the jobsite
before the first i p ction. If you intend to obtain financing, cons"ul I h lender r an a orney before
commencin w r r recor n ur Notice of Commencement.
7/vv
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_ Signatukeo6f Owner/ Lessee/Agent
Signature of Contractor/License Holder
STATE OFFLORIDA ��iFLORIDA
SZ-1�� �U
COUNTY OF hv�
COUNTYOF
The going ins r ment was acknowled epefare me
this � day of 20/�by
The fo ing ins ment was acknowledged before me
day of200_by
this �lpae�&hkdging:�d)�
(Na
a e of person ack ledging)
1
Signature of Notary Pu c- k2ate of Florida)
(Signs ure of Notary Public- ate o lorida )
PersLaItJ,,X�XK0pplVn ryr� ation
TypatioptBfEijdpja i a
My Comm. Expires Mar22
Personally ewcfdda�tif�atin
T e ofde ti •"I DAWN MILONE
YP �dNotiry u Ilc -State of Florida
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7
�:= Cemmi«,.,., .. EE 817�
My Comm. Expires g)2017Commissio !� 'Com`
+„ - ommssl"'
• Bonded Through National Nota ryAssn.
'' %° �� k'` BotMad ThreoBh National Notary Assn.
Revised 07/15/2014
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