HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �- Permit Number:
2a._—.w:= :x°:w0r;�._Wim= Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34.982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential _X
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
.DSI=D..IMPROVEMENTLOCATIflN:'::;�.::: :.: : .: .
Address: Sq4 SC fkkv� 0(
Legal Description:
Property Tax ID#: 3y� - 311- GoE a • UOQ- Cl LoL No.
Site Plan Name: Block No.
Project Name: 'LC-feo^o Lew's
Setbacks Front Back: Right Side: Left Side:
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Additional wor to l3e performedunder this permit—cheCK all apply:
6HVAC LI Gas Tank Das PipingShutters �Windows/Doors
OGenerator
Electric Plumbing Sprinklers Roof
Total Sq. Ft of Construction: Sq. Ft, of First Floor:
Cost of Construction:$ Utilities: _Sewer Septic Building Height:
RACTOR...:.,
Name Lo rgin,_ 2wis Name: ~IQCiCwitIl CxAa Sans f11C
Address: ZALA SF j-}iM-n f ivu irlr Company:
City: Y-e,zR State: FL Address: S11 S-� Luc-.k uric
Zip Code- -!)`-1C� 5 Fax: City: V} Q:(,rce State- FL
Phone No- _!�_41.• 46I- 10 0 b Zip Code: IM Cl LAV Fax:
E-Mail: Phone No.--RL-L4Lol- IOCC
Fill in fee simple Title Holder on next page l if different E-Mail:
from the Owner listed above) State or County License:
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SU.P,P..LEM_N l�.L.fiQNS 'RUCTION.-Ul =W AW NFR
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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.
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,l 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.
S
_Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORID ' r-.. STATE OF FLORIDA C� ,
COUNTY OF � t I� COUNTY OF 1' '
The fcW ing instru.rent was acknowledge before me The °.Ving instru t'was acknowledged before me
this L-,eL_day of I 1 1- r^ 20 ab7 this () day of 9, 20 1y
no
(Namg pets n acknowle gjng) (Namerof pets -acknowledging)
id 7
(Signature p�o`tary/Public-State of Florida) (Signatureotary Publ ate of Florida)
Personally Know rT' OR Prod n Personally Known OR Produced Identification
Type of Id i,peg ,en Pr,Qu� Type of Identification Produced
Commissio I�o. s Y` ff`'COMt"tlSSION rF448072 (Seal)
August( 8ioi B Commission No.
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TRACY KAY LANG r
Revised 07/15/2014 ',s
My COMMISSION#FF148072
8
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DATE
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