HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE I FO M ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: � Permit Number:
a
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 LOCATI
Address: 15.2-q AIW biuffimhush. ej'�� Im (Aw
Legal Description: .11a.r{ iA.y- lZi LlP_ - 0 xi ( VI
Property Tax ID#: q�2(D'" iii 15- 002-6 000-3 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
rCp`ci,Le. 5 w 1►4ows On& 2 sI l dl"�I g a sc oho rs W I n4o'_X_+
t 1 n5i-7u11 rnrJkQ r12ze-A roll 61ru, fs . 1 ns+IL ` o vi e,
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CONSTRUCTION INFORMATION;
Additional work to be nertormed under this permit—check all that appy:
HVAC Gas Tank ❑Gas Piping E]Shutters windows/Doors
Electric 0 Plumbing ❑Sprinklers liGenerator Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: Sewer 0Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name vz"` '0 Name:
Address: 09 Lid h r1a h. Company: 0
City: ClIa Sfnn bilil State: (i_I Address: gla6
Zip Code: 003-3 Fax: City: PQ uICu State:y2
Phone No. S(Dn— (P3.., x w3 Zip Code: GgQ63 Fax:
E-Mail: Phone No. 7 72 A60-02-00
Fill in fee simple Title Holder on next page(if different E-Mail: r GT P C-e 0,�jc�Mo. C eDk'�
from the Owner listed above) State or County License: 2:10-7 1
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
5000l EMENTAL NECONSTR`UCTION�LIEN LA1N.(NFOR"MATI0
DESIGN ER/EN GI , . . ,, ,>..: . _ ..... ._
ER: _Not Applicable MORTGAGE COMPANY: _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 Owner/Lessee/Agent Stifnature of Contractor/License Holder
STATE OF FLORIDA - STATE OF FLORIDA
COUNTY OF S-{— L-Li Cites COUNTY OF f-'LA.c c -e
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this U: day of �. rl� . 20 faby this-lk-k-day of AWiV .20 [5 by
(Na of person acknow ging) (Name of person acknow dging)
(Signature of Notary Public-State of Florida) (Signature of Notary Publi -State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produce I Type of Identification Produced
GAtE FtJf_tF_F',
Commission No. 'N. L ;QS1�)COM(vlISSIONFFO8Vn fission No.
o;
EXPIRES October 20, 2017 COLI; FULLER
(4 D7)30-0153 Roridallota Services m W. MY COMMSSION 4-FF0645
Revised 07/15/2014 - •'.�FOF��pExPIREs October 20.20
(507)39B-0153 Floridat4otaryservice.com
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