HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE AC CEPTED
Date: 7�J3�/ Per nit Number: 1 -71
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 airow at the end of line
PROPOSED,IMPROVEMENT LOCATION:
Address: c2 e-
Lega I Description: S/Arid 01 Al u
Property Tax ID#: 3 ycz + -7 7 r 6 D eq-O Lot No. - -
Site Plan Name: Block No. 3
Project Name:
Setbacks Front Back: Right Side: Le ft Side:
DETAILED DESCRIPTION OF WORK:
1&?I t ee- 30
J r?7`
CONSTRUCTION INFORMATION:
Additional work to 13P nerrormed un ert is permit-c ec a app :
HVAC Gas Tank E]Gas Piping _Shut ers ,Windows/Doors
Electric Plumbing Sprinklers Gen rator Roof
Total Sq.Ft of Construction: S Ft.of Firs Floor:
Cost of Construction:$ y Utilities: Septic Building Height:
OWNER/LESSEE: CONTRA OR:
Name Name: o T�G6
Address: oZSO- 4ihe -7724., Company: e-.r `s
City: S L State: Ae Address: `�Oo2 -Sar 0
Zip Code: 3 `�`� Fax: City: .J L State: 6e-
Phone No. 3 Ss_16 Zip Code: 3 Yf--z Fax: 33-T--Zd�a
E-Mail: Phone No. 3 3 7 *3 6 ?d-
Fill in fee simple Title Holder on next page(if different E-Mail: (EJ:1 .9-
17
from the Owner listed above) State or COL my License: GL l'Y•Z y !v 3
If value of construction is$2500 or more,a RECORDED Notice of Commenceme it is required.
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.aJPPLEMENTALOONST.JGfION UEN LAW-IN F01 (Vi-An
DES BR!ENG NEER _Not Applicable MORTTGA COM PANIC _Not Applicable
Name: Name:
Address: Address:
City: :tate: MY: date:
Zp: Phone: Zip: Phone:
FEESIMPLETIlTEHOLDER ,Not Applicable BONDIN OOMPAW. Not Applicable
Name: Name:
Address: Address.
City: City.
Phone: Z.tp: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
W Lucie 3untyymakes no repressr�Cation t hat is grantinga permit will autho ' the permit holder to build the sub'fect structure
whrch is to oonf[Ict with an ppltcable Home OwnersAssoclation rules, laws r and covenants that may restrict fir prohibit such
structure Reaseconsult> it?your Home tavnersRssoaatlon and remewyour ec-d for any resfnctionswhich may appty.
Inconsideration of the granting of this requested permit,I do hereby agree the I will,in all respects,perform the work
in accordance withtheapprovedplans,the MoridaSul ldingODdesanda.Lucie County Amendments
'ihefollowing building permit applications are exempt from undergoing a full a ncurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and a ry uses to another non-residential use
WARN INGTO OWNER Your failure to Record a Notice of Oom mena ment may result in your paying twice for
improvementsto your property.A Notice of Commencement muE t be recorded and posted on the jobsite
before the first inspection.If you intend to obtain financing,con It with lender or an attorney before
commencina work or recordina vour Notice of Commenoement.
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gneture of Owner/Agent/ natureof ntrad:or License er
STATEOFFLORIDA — SrATEOF RDA
C)OUNTYOF .S / G u G r'-e COUNTY F 57- G
The forgoing instrument wasadcnowledged before me The forgoi n instrument was acknowledged before me
this/3 day of 5K 20 Xby this /3 d of �k ,20_Lfby
(7gnurjDJ!Vatai,'y
person in (Name pe n ad{ )
Publi a of Florida) (9gnature b6tary Io-gat of rids}
Personally ;r� on Person ion
Type of Id F408 pr. TYpeof � O�n bFfrLt•A7RIf1r
MY COMMISSION*FF23
CbmmiSso I ...•, EXPIRES Commi XPI 2Q1� .
..cn .r�b� µCr;'rni U*Se3 Flor�lgNoq enice.earr
Revised 07115120I4
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CONTCOUNTERUHi 1�MBN REVIEW FBABN F�1AEW fi��/BIV FSAEVV
DATE
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