HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED l ��
Date: Permit Number: fJ
54C lila 7 —0q& J
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
PROP-3PD UIVIEPR®U MENT L®CATI'®N: BONN
Address: 6�4- 4-1 7 e-2
Legal Description:
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
°ICED DESCRIPTI®N QF W®RK
C®NST'R�UCTION IN:F®R ATI®N � ,.
Additional work toe e orme under tis permit—checka appy:
HVAC Ei Gas Tank Gas Piping _Shutters O Windows/Doors
Dlectric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction:$ ��x� Utilities: _SewerEl Septic Building Height:
x-w?-'t vc
OWNER%LESSEE CONTRfACTOR
_
Name ` Name: ;
Address: Te!�� . eX Compan.l.
City: State:, Address:
Zip Code: [ F..ax. City: State:
Phone No. \� .� Zip Code:���{r� Fax: 7QE
E-Mail: Phone No. .rte/ o/7
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County Li ense:,2'Z_ S�
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
` Sl1PRLE;M�E��,NTAL CO QTR+tJ�TI:®N. �I�EdN LAW INF®RaMAI"fON� � ��
. .;. nei;
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: a Not 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 thepermit 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
_Signature of 0 er/Lessee/Agent gnature of Co ntr or/License Ho er
STATE OF FLORID STATE OF FLORIDA
COUNTY OF C �_ COUNTY OF U�Gt
The forgoing instru nt was acknowledged before me The for oing instrument was acknowledged bjore me
this51
_day of 201,�by this day of��t �Ncl 20 L—�_by
uA�CJZ�N
(Name of person acknowledging) (Name of person acknowledging)
LQ� V
(Signature of Itary Public-State of Florida V 14 (Signature of N Vry
Public-State of Florida)
Personally�C ion Personally Known OR Prod ed Iden ification
GE HUFF Type of Identi
Type of I ec�1 �dpn Prod yp `,�����of p
Notary Pu 1C- ate of orida ,��0 y o, ANGELA M HUFF
Commis
• :•_ Commission#FF 2 �9 Commission �a •`�= Notary Public-S(a5@?+ lorida
�,F °P�.• ares May 27,201 �• Commission#FF 234730
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onded through National Notary Assn.
Revised 07/15/2014
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DATE
COMPLETE
INITIALS