HomeMy WebLinkAboutBuilding Permit Application .j/ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 Residential
Phone:(772)462-1553 Fax: (772)462-1578 Commercial
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line -pt&,Mb
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Address: 7 VLIQ
Legal Description: _.(ZAn '0 Dd 160eL CJS'116J (�LnAL22 4A,1 AIL
Property Tax `3 0 0 0 '(0
ID#: Lot No.
Site Plan Name: Block No.
Project Name:
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Additional work to bMeeff6rmecl uncler this permit—check all that apply:
[J HVAC Gas Tank Gas Piping- Shutters M Windows/Doors
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Electric W,Plumbing OSprinklers Generator o Roof
Total Sq.Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ Wcid_ Utilities:F]Sewer F]Septic Building Height:
Name Name: 'Yo%,V, U z
Address: 7- & Company:P�e( 0 1�A I JVXV)ti-S
City: State: Address: -7s-o' V Z aka e.--*k 3
Zip Code: S Fax: CityTA"e(c e State
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No. 330-441411 Zip Code:; f 9<-/ — Fax:-77;—q4;1
E-Mail:_ ha4Ct11!t1Z1JVA1>1**n!R4e1a CO)" Phone No. 7ZP-=1 14S 9() q&
Fill in fee simple Title Holder on next page(if different E-Mail: -d 6.r. I-Wer q,01,\W.C_aV-q
from the Owner listed above) State or County License:C
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of construction is$2500 or more,a RECORDED Notice of Commencement is required.
yS'UPPLEM;ENTAL,CONSTRUCTI LIEN LAIN INFORIVIi4TI0N.
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DESIGNER/ENGINEER: A Not Applicable MORTGAGE COMPANY: A-olkot Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _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, 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 a first inspection. If you intend to obtain financing, consult with lender or an attorney before
cgwTiy6,ndngwqXkotxzL_ording your Notice of Commencement.
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Cor_ ignature of Owner/Lessee/Agent ature o ctor/License Holder
STATE OF FLORI TATE OF
COUNTY OF , t . � v G-C COUNTY OF FLORIDA,��, L ck c.
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
thisoZdday of l�� 20 1.�y thisX"day of In)Q� ,20 by
UOIPlkrVIc �o�N G�ye-0-
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known )�_OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
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Commission No. (Seal) Commission No.FFQJ (Seal)
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Notary Public•State of Flodde • Notary Pybric-State of Florid#
Revised 07/15/2014 •_ Comm.ExpiresOct.8 2017 , t `` My
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DATE
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INITIALS