HomeMy WebLinkAboutBuilding Permit Application Jun 0115 03:03p First Choice Plumbing ry 7728797860 PA
ALLAPPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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
PROPOSED IMPROVEMENT LOCATION:
Address:�\M M kk(D2S V �.k : �L-n
Legal Description-.Ic1�- -, \ nr) Da��- er-
Property Tax ID#:'NJq-t)0-UcC4 Q
Lot No. 43
Site Plan Name: Block No. Q
Project Name:
Setbacks Front Back: Right Side: Left Side:
[DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Adchtional work to be performed under this permit-check all that apply:
[)HVAC OGasTank R Gas Piping 1i Shutters WindowslDoors
OElectric EDIKUmbfng OSprinklers F-1 Generator 11 Roof
Total Sq.Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ X) Utilities:[]_Sewer n Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Nam"- NName--iim�—
Adclress:hci�� +1���-\ � Companyuaye-k 1'r-& \
city,\JA,SL �i--g-Ae State:` Address Qn CT_k Jal5d(l, P,\q 61
Zip Code: Fax- city: 4- �-ulc Cf State:
Phone N6. -
Zip Coder CW+ Fax j-*'A
E-Mail: PhoneNo.'-A
Fill in fee simple Title Holder on next page(if different E-Mail 1 �J
from the Owner listed above) State or County License-.(
If value Of Construction Is$200 or more,a RECORDED Notice of Commencement is required.
Jun 01 15 03:03p First Choice Plumbing 7728797860 p.2
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORM ION:
DESIGNER/ENGINEER: ,Not Applicable ORTGAGE COMPANY: Not Applicable '
Name: Name:
Address: Address: .
City: tate: City: tate:-'-
tate-
zip:
ate:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLD _•Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Phone; Zip: Phone:
I certifythat 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.
s
ignatu o Owner/Le7r,
gent JTNITY
ure f Con ractor/Licens Holder 4
S ATE F FLORIDA / , 03%FLORIDA l� ct
UN OF bL O
I The for ent was acknowledged b re me The fo rg nstrument as ac cnowledged re me
this ay of /l/fi 20 by this of 20 by
(Name of person acknowledging) (Name of person acknowledging)
ye�
(Signature of NotarV Public-State of Florida (Signature of Notary btic-State of Florida)
Personally Known OR Produced Identification . Personally Known OR Produced Identification
Type of Identification Produced Type of identification Produced
Commission No.Er- 3 ,� P" :, NANCY LEE L � No• �56� —
� Seal
MY COMMISSIO N EE830242
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Revised 07/15/2014 EXPiRES,,•lab., 1
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS