HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number: ' SSW' 0 33(G
SCANNED
BY
Building Permit Application St.LudeCounty
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34981
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line I
Address:
Legal Description:
IJ kilt- 7263
Property Tax ID #: 9 5 2a - (r oa - oo 27 - o0o - Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: LeftSide:
Block No.
MUU I LIU[ Id I WU I K LU❑e PCf IUffrleU Uncierimis permit—cnecK all apply:
11HVAC Gas Tank ❑Gas Piping _Shutters ✓Windows/Doors
11 Electric 0 Plumbing Sprinklers 1:1Generator Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ ,� Utilities: Sewer E]Septic Building Height:
OWNEI /LESSEE �` '
,e.: `_r. ht r'"e:x. " �,r ut. .`r_r.. '.f:'«tiai'u
;CONTRACTOR
Name
Name: Richard Chariton
Address: 1114 go ,S. o ,t)r. r(2(aA
Company:
City:TQlLSori &OC11 State: VL
Zip Code: 3`4015`7 Fax:
Phone No.
Address: 16585 106th Terrace North
City: Jupiter State:Fl
Zip Code: 33478 Fax:
Phone No. 561-339-7110
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail: Richard@palmbeachwindow.com
State or County License: CBC059351
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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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:
I certify that no work or installation has commenced prior to the issuance of a permit.
no
e the permit holder to build the subject structure
or and covenants that may restrict or prohibit such
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 i to obtain financing, consult with lender or an attorney before
commenci ork or recording our No ice of Commencement.
s
_ Signature of Owner/ Lessee/Agent
Signatu a of Contractor/License Holder
STATE OF FLORIDA
S-t(— Oc
STATE OF FLORIDA
COUNTY OF . I
COUNTY OF terra\rk ay_a .'1
The forgoing instrument was acknowledged me
The forgoing instrument was acknowledged before me
,j¢efore
this day of uhg 20 Lby
this day of 20 1- by
Kic ra CIn1r1-}oY)
�1�\(\���ffifinn
(Name of person acknowledging)
(Name of person acknowle Bing )
(Signature of Notary PublickState of Florida)
ign ure, of Notary/Public- State of Florida )
\`E��ryo
Personally Known OR Produced Iden ' '
a
P� na Known OR Produced Identification
,to
Type of Identification Produced V�
ti'p`e of Identification Produced
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Commission No. (S,r��OFO`.`55�°a��`°
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Commission No. F-/ UU (Seal)
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;z • '` 0p0 �'' ' °a. Notary Public - State of Florida
Revised 07/15/2014 g= y' My Camm. Expires Aug 10, 2015
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