HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED .2
Date: Permit Number: ��
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Building Permit Application
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: To Select from dropbox, click arrow at the end of line
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Legal Description: UTA QLPA ahtawA At Sa-"Rah ft,.Lb CeE —42-2(4)
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Property Tax ID#: 003lo - oo7-q Lot No. I
Site Plan Name: cc�� Block No.�
Project Name: :1W
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Additional work to be nertormed under this permit-cneCK all that appy:
aHVAC Gas Tank ❑Gas Piping Shutters Q Windows/Doors
11 Electric 0 Plumbing Sprinklers FIGenerator Q Roof
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction:$ 0, 2100. 00 Utilities Sewer Septic Building Height:--
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Name + 1 1L C- Name: WGICU'S GIMM3
Address: Company:
City: -(', (a "e- State: Address:
Zip Code: 95i Fax: City: Stater
Phone No.]-1.2-FS:JR - t_DsC11 Zip Code:{�� Fax.-I'12A1.011200
E-Mail: - - Phone No.'_Q2A1124J9X0C
Fill in fee simple Title Holder on next page (if different E-Mail: 1
from the Owner listed above) State or County License:f- :C 2.(e
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 TITLE HOLDER: _Not Applicable BONDING COMPANY: _L-111ot App licable
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.
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 appl y.
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 wit ender or an attorney before
comme work or recording o tice of Commencement.
Signhbde of Owner/Agent/Lessee Signature of Contractor/License Holder
STATECOUNTY OF ORIDAO STATE OF FL
3 Gt P COUNTY OF.ORIDASV LA X p ,
The.f,o.rgoing instru ent was acknowledged before me The forgoing instru nt was cknowledged before me
this'2,'l day of � 20 14 by this�� day of Y1Is 20 14 by
(')I of o cka r As
(Name of person acknowle ging) (Name of person acknowle ging)
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(Signare o Nota Publi"Stateof rid ) (Signatur of No ary Pu lic- tate f Flo ' a)
Personally nown ✓ OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. SIA pE-STAFN mmission No.
MY COMMISSION#FF1254 0 +p�!"t�`'4; SONIA DESTAFN
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Revised 07/15/2014 I4o7)3sa_0153 FloridallotaryS r4"A otss di EXPIRES May 21,201
407)398.0153 FloridallotaryService,com
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