HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE AC EPTED
Date: 6 Z/ .711-C" Per it Number:
16=61900M
0M RECEIVED
Building Permit Appli ation
Planning and Development Services JUN 16 2015
Building and Code Regulation Division
230D Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click ar ow at the end of line
PROPOSED IMPROVEMENTLOCATION:
Address: 7 Y/o2 G d e /S 19/1x Ge
Legal Description:
Property Tax ID#: 3 3�..� r0 4 0/ Q 0 ^-� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Lel t Side:
DETAILED DESCRIPTION OF WORK:
,Qel/*Ldr .So cA-.�c o 7-
e e
CONSTRUCTION INFORMATION:
Addnional work toe eftormed under this perm —check all p y
HVAC Gas Tank ❑Gas Piping Shutt rs Windows/Doors
11 Electric aplumbing Sprinklers 1:1 Gene ator 0 Roof
Total Sq.Ft of Construction: S�Ft,(of First Floor:
Cost of Construction:$ .j sD. Uig Utilities:USewer Septic Building Height:
OWNER/LESSEE: CONTRA OR.
Name G Ole le- /f D IP-40 Name: o Shy d G
Address: 7,Y4--1 L.A,-.�% ! /•�cr- Company. ej,%r Gsc �2.h
City: 1�a�--f do" yc State: Address. Q 1�&' �
Zip Code: 3e(`lggl, Fax: City: so Lunt State: /C
Phone No. 7'7.2- YG If 91?/ Zip Code: 2, `tri X02Fax: 33s�68v
E-Mail: Phone No. 3 7 368"
Fill in fee simple Title Holder on next page(if different E-Mail: pt 's
from the Owner listed above) State or Cou ty License: 4
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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9UPPLEME'4TAL00NSTR JGn0N UEN LAW INFORMAII
DEEIGNHFIEWNBER _Not Applicable MORT GEOOMPANY: Not Applicable
Name: Name:
Address: Address:
City. Sate: aty: date:
-7J p: Phone: Zlp: Phone:
FEE SMPLETITLEHOLDER _Not Applicable BONDIN OOMPANY NotApplicable
Name: Narne:
Address: Address:
p Phone: Zp
ZPhone:
certify that no work or installation hasoommenced prior to the issuance of a permit.
a.Lucie County makesno representation that isgranting apermit will authori the permit holder to build the subject structure
which ism conflict with any lic Eol Home Owners Ass ciation rules,bylaw or and covenants tl1�t may restrict or prohibit such
structure.Please consult wit your mme Owners Association and review your eed for any restnctionswhich may apply.
In consideration of the granting of this requested permit,I do hereby agree th, I will,in all respects,perform thework
in accordancewiththe approved plans,the Florida Building Codes and Et.Lucid Cbunty Amendments
Thefollowing building permit applicat ionsare exempt from undergoing afull ncurrency review.room additions,
accessory structures,swimming pools,fences,walls,signA screen rooms and a cessury usesto another non-residential use
WARNINGTO OWNER Your failure to Record a Notice of I)Drrimena ment may result in your paying twice for
improvements to your property.A Notice of Commencement mu be recorded and posted on the jobslte
before the first inspection. If you intend to obtain financing,consE It with lender or an attomey bef6re-
commencinq work or recordingyourNotice of Commencement.
C
gnatureof UWnerl Agent/LesseeurqoC�!Pgtktorl License bolder
STATE OFFLORIDAy STATEOFORIDA.
COUNTYOF J vGi'� COUNTYCF
S,
The for in instrument acknowledged b ore me The For in instrument acknowledged b fore me
this day of 20 ? 5y this�clof �:�, 207by
nsr
7t,/x
(Name of r n edgin (Name o peson ging
gnature df Nbtafy Pu ic- of Florida) 9grlature c Public- at f Florida)
Personal ,► ion Parson I Eation
Type of I ori!@� r Type ol IN iP �te �s36
CbmmiEXPIRES May 21.2Gummi 0. : EXPIRES May 21.2011
•' ' s:��.�,m Moexorr
Revised 07/15/2014
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