HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICAB E IINFIO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED i
Date: ` P I O Permit Number: I
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578
PERMIT APPLICATION FOR:
Address:
Legal Description:
Property Tax ID #:
Building Permit Application
Commercial _ Residential
SCANNED
BY
St. Lucie County
Lot No.
Site Plan Name: Block No. .
Project Name: _ 11711 / yy P/217
Setbacks Front Back: Right Side: Left Side:
Mechanical
Electric
Tank
— Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
Piping ems% Shutters
_Sprinklers _Generator
Sq. Ft. of First Floor:
Utilities: ._Sewer _Septic
—Windows/Doors
Roof
Building Height:
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Name dlcx dd ,
ame:
Address: );-.I% ( c
ompany:19rf2nr Ga c
City: fi�xAG_V l s State: W -
Address:_ 33a/�
City: /7irT //err+ Stater
Zip Code: Fax:
Phone No.Z�� < "'_E' — 's I
Zip Code: 3 f/9 J0o? Fax: 2 2 z - �9 - JOY 0
Phone No. 77a -633 •07S/G.
E-Mail:
Fill in fee simple Title Holder on next page (if different
E-Mail: i o
State or County License: 10
from the Owner listed above)
it value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
J q
���;
DESIGNER ENGINEER: _ Not'Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City:
Zip:
State:
Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Address:
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.
structure. Please consult with your Home Owners Association ana. review your aeea Tor any restrictions wmcn may appry.
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 concurrencyteview 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
im ments to your property. A Notice of Commencement must be recorded and posted on the jobsite
fore th fir ssppection. If you intend to obtain finan c suit@Wlender or an attorney before
c menAne arkbr recordine vour Notice of Commen e rfrient /'�k \
SI na ur of Agent/Lessee
a ureo nPactor/LlcebseHolder
STATE O RIDA
STATE FLORIDA
COUNTY OF _37 Lucie
COUNTY OF Si Lyci�
The fa oing instruTent was acknowledged before me
this day of 20 by
The for oing Instrument was acknowledged before me
this day of 20�by
L�csis-4-r�
(game ot•person ackn edgin )
(Name of perso nowledging )
Notary
(Signs ure of Notary Publio- Staterbf Florida)
(Sign lure of Public- St9ite of Florida)
Personally Known V ORPI
ly Known _ ced IAfYftKW6n MILEY
Type of identification ProduceMICHAEC-MI
IL%e o dentiflcation Pro a :•= !s_aln_i
MY COMMISSION q
No. 4V c)17Gal) EXPRES July 18,
E217WOl7W JCommission
2liWMi ion No. e/F 153
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COMPLETED
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