HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE P CCEPTED
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Date: f�i(1 Pe mit Number:
i ® S
Building Permit Application
Planning and Development Services
Bui(ding and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax:(772)462-1578 Commercial Residential r
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSE[?-IMPROVEMENT LOCATION:
Address: I`� W/�/d t..., -f s
Legal Description:
Property Tax ID#: l SAO 00 1-7 D O'O Lot No. 3
Site Plan Name: Block No. 3
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION-OF WORK:
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CONSTRUCTION INFORMATION:
Additional work to be performed under tis permit-check all that app
HVAC Gas Tank Gas Piping _Shu ers 11 Windows/Doors
FlElectric 'Plumbing Sprinklers []Gen rator a Roof
Total Sq.Ft of Construction: S(1-
Ft.of Fir Floor:
Cost of Construction:$ X sQ• 4'o Utilities:!Sewe Septic Building Height:
OWNERf LESSEE: CONTRA(TOR:
Name S z.-t W.0-/ju 2 Name: ,i 9 S Q/'�Y F _ 7-4-t Ley
Address: P2 770 Scd as 4C-4- Company: C%* , f-S,`J �La,,, ,k 5�:,•c
City: Al r State:iC e: Address: to-a;2 S!s 45/ ^
Zip Code: 3 3 3 3 Fax: City: 1 e State:�IfG
Phone No. Zip Code: 3 Y f Fax: 3 3x .2'r80
E-Mail: Phone No. 3 2 7 36 ?,Z
Fill in fee simple Title Holder on next page(if different E-Mail: e-f%t
from the Owner listed above) State or COL my License: e—'
if value of construction is$2500 or more,a RECORDED Notice.of Commencernei it is required.
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DESIGNEVENIGNaRR Not Applicable M ORTGA 73E COMPANY: Not Applicable
Name: Name:
Address. Address.,
City: State: ( City: nate:
Zip: Phone: , Zip: Phone:
I
FEESIMPLE7ITLEHOLDa ^Not Applicable BONDN ODMPANY. Not Applicable
Name: Name:
Address: Address
(qty: City:
Zip: Phone: Zip: Phone,
I certify that no work or installation has commenced prior to the issuance of a permit.
a.LudeCounty.makes no representation that isgrantingapermit will authori the permit holder to build the sub11ectstructure
which is in eonfliat with any applicable Home OwnersAssociatlon rules,bylaws r and oovenantsthat may restrict fir prohibit such
structure.Reaseconsult with your Home Owners Association and review your, eed for any restrict►onswhich may eppty.
Inconsideration of the granting of this requested permit,l do hereby agree th I will,in all respects,perform the work
in accordance with the approved plans,the RoridaBuildingCodes and El. Lucie County Amendments.
'The following building permit applications are exempt from undergoing a full ancurrency review:room additions,
accessory structures,swimming pools,fences,wells,signs,screen rooms and acessory usesto another non-residential use
WARNINGTOOWNER Your failure to Peoord a Notice of C ommen ment may result in your payingtwice for
improvementsto your property.A Notice of Commencement mu be recorded and posted on the fobslte
before the first inspection. If you intend to obtain finanang,consL It with lender or an attorney before
oornmenana work or recordina your Notice of Commencement.
gnature of Owner/Agent/ natureof ntraactorl Licence er
STATEOFR-OPJDASrATEOF MDA
COUNTYOF= .S G u C r'X2 COUNTY F 57- G u G q—
The forgoing instrument wasacknowledged before me The forgoing instrument was acknowledged before me
thisZ3 dayof :u 20 by this � d of 5� 20_Irby
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gnatur of PUbli eofFlorida) (Sgnatureo tary Io-gat(of rida)
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