HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: (o I a5) Permit Number:
•
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 CO ercial idential >C
PERMIT APPLICATION FOR: x clic �e-en—Rne—
PROPOSED IMPROVEMENT.LOCATIQN ,
Address: 11o810 NN l?:U 4onbusV-) CI rc�e, Palm Csty , PL 3L4-qQQ
Legal Description: -ACLrbnvis IZi dQf-. -• QCL� lcl r Ta.11ov'Jonr4yi il(�C41eIr-+ (l
PropertyTax ID#: +4-,ab- 84-C)- 00i0-000 - 3 Lot No. �I
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION C►F WORK
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RAM isr ictiS} lm pCtCt Vvind
CONSTRUCTION INFQRMATION
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Additionalwork to e e Orme under this permit-check a appy:
HVAC EiGasTank
—]Gas Piping Shutters �llindows/Doors
Electric 0 Plumbing Sprinklers 1:1 Generator E] Roof
Total Sq. Ft of Construction: I`5$ Sq. Ft. of First Floor:
Cost of Construction:$ yjiC'� Utilities: Sewer(Septic Building Height:
OWNERjLESSEE CONTRACTOR:
Nalne Na* et.
Address: :I(o`ako't AW. at I )E)b t sh Cir. Company:
city: \(``1 (� \VL:\ State: Address: 511 Ld�C1 ('
_.
Zip Code: '��\-q i ...
Fax:------..,' City:_'. S IaC��C ` State: 'P L
Phone No. Zip Code: ���C(�I`] Fax:
E-Mail: C bW_ffl Sa5%l wn b Lof0 Phone No. "1_'I ` Oa01
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State o Coun/ License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUI?`PLEMENTAL CONSTRUCTION LIEN LA1N INFORMATION v
DESIGNER/ENGINEER: _ 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 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 fist inspection. If you intend to obtain financing, consult with lender or an attorney before
comme cin .work orrecording our Notice of Comm encemen .
s
S'gnafure of dwner/Lessee/Agent -� ignaure�f Contractor/License Holder
STATE IDA FLORIDA ,� D
COUNTY OF S+ �6L COUNTY OF S c �C�k,
The forgoing instru ent was acknowledged fore me The forgoing instrument was acknowledged before me
this day of 20/5—by this day of 20 l by
/01D 'hcabs
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary70R
ric-State of Florida) (Signature of Notary i State of Florida
Y )
Personal) Known Produced Identification Personally Known �OR Produced Identification
Type of Identification Produced Type of Identification Produced
�"•�' KEIT
..,• ....... FROCK ........
Commission No.f F ) ��� Commission No.�F I( 't KEIT!(fiFROCK
Y COMMISSION#FFl65768 '. :.
my CO
MMISSIO #FF165768
EXPIRES October 5.2018 :+
(407)398-0153 FioridallotaryService.com (407)398-0153 FloridallotaryService.com
Revised 07/15/2014
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