HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONyr
ALL APPLICABLE INFO MUST BE COM'rccrED FOR APPLICATION TO BE ACCEPTEL" t
Date: - Permit Number: S -_
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Building Permit Application
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Planning and Development Services •S�1tiLRY441-
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:
PROPOSED IMPROVEMENT LOCATION:
Address: Lfl Ro "/-rr4- (.} &A"d)y /4 Zk FOIL- 6154
Legal Description:
Property Tax ID #: 1/�
1 Lot No.
Site Plan Name: ULU � �y 11 Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
.DETAILED
DESCRIPTIONOFWORK
nll� Ova e��'roanc �owSF cSPF 4-r 0 '0;�Z_� Stcs..ss
CONSTRUCTIOWINFORMATION: 2_
Additional work to e performed under tispermit-checka apply*
0HVAC E] Gas Tank Gas Piping Shutters Windows/Doors
11 Electric 0 Plumbing []Sprinklers Generator Roof
Total Sq. Ft of Construction: �*-G, L S Ft. of First Floor:
Cost of Construction: $ f Ob�l(oT Utilities: Sewer Septic Building Height:
DOWNER%LESSEE:` °
°CONTRACTOR ,,'_;
NameOoCAvIQuC OCCAmP f- co.v0aiwim— A!/ociArw,
IT
Name
Address: rf r F v /V , Ffwy . A J_q
Company:' c_ er" r-D" A1c Jam'
City: j%1 • State:
Address: / S-3 1 W 7 = Are_
City: Stater
Zip Code: 3 Y f V S Fax: s
Phone No. 321- 7 (eh0- (, OO,S-
Zip Code: ` 3D(vo Fax: "Sci-IM- /OS,4e
Phone No. 9S-V dl -If-78
E-Mail:,7wuE� J'R, rLWa-rTA4LfA/LIc-L, eoM
Fill in fee simple Title Holder on next page (if different
E-Mail: l7E7Gu-P &Ot-R&°r d i -3
State or County License: Cze-I3Z 9-0
from the Owner listed above)
If value of construction is $2500 or more, a RECORDED Notice of commencement is required.
SUPPLEMENTALCONSTRUChI N:LIEN LAW_ INFO
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: _
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name: _
Address:
City:
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 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
commencing work or recording our Notice of Commencement.
ignature of Owner/ Lessee/Agent Signat qi0_f-9ontra(ctor/LicV
se HolderIJ
STATE OF FLORIDA
COUNTY OF S 2• f�rc c�
The fng instru enY as acknowledged before me
this;" day of 20 (Cby
(Name of person acknowledging)
(Signs r f Notary Pt} ic- State of Florida )
Personally Known J/ od ovary �Iaggj I e
Type of Identification PP
My Commission FF 963355
Commission No. aP, Expires 020
� b33
Revised 07/15/2014
STATE OF FLORIDA
COUNTY OF '14-rVD
The forgoing instrument was acknowledged before me
this 2 day of /71 /J-t 20 /� by
b c-vs cy-J
(Name of person acknowledging)
:��A ;)-, �;-
(Signa of Notary Public- tate of Florida )
Personally Known Q2�8513ct1+ftfiL�lfa
Type of Identification Pr rotary Public State of Florida
//�� My commission IFF 9633s5
Commission No. q(0 ok' FVIres
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