HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (�
Date: Permit Number: —" d
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 y/
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION: y'
Address: 4i c1a1 erl pi,1-cr_5 Rc�,_
Legal Description: N-tcuen zs'emrc.� QA V-- 0 + I
Property Tax ID#: d6a3 • `)D ' (Do D3 • (Y--Z • 1 Lot No, 1�222+`�'l
Site Plan Name: Block No. eD
Project Name: -ok-;s
Setbacks Front Back:O Right Side:O Left SideC)
DETAILED DESCRIPTION OF WORK:
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pod R�C�L(�_X s:
CONSTRUCTION INFORMATION: J '
Additional work toe e orme under this permit—check a appy:
1]HVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors Ll
11 Electric 0 Plumbing Sprinklers I Generator 11 Roof
Total Sq. Ft of Construction: S Ft.of First Floor:
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Cost of Construction:$ J 030 — Utilities: _Sewer O Septic Building Height:
OWNT LESSEE: CONTRACTOR:
Name o'1aA68Y-VL�4Name: ex-);ej Lct,LY
Address-s': 3l 1 tcV%c CA e, � ( i'l� � Company: �e�S r'�f 1L�_ QQCP
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City: + Pi e(Ce State: R_ Address: IRW�s �& -
Zip Code: el�5 Fax: City: &�L- /I_ State:_l_
Phone No. Zip Code: 3* 01_1 Fax: R�S aS
E-Mail: Phone No. -1-1 A%25 - _' 3
Fill in fee simple Title Holder on next page(if different E-Mail: e(1C'_�E :UGV".
from the Owner listed above) State or County License: cZt2al�
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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 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 Ow r/Lessee/Agent Sigrikure of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this A'l day of ,,,t 20!2!L-by this S day of IAL< 20 IS by
QrD t SM 4-h. f� n't-t-_A, Lu,�tre ice-
(Name of perso cknowledging) (Name of person acknowledging)
Y Q id
(Signature of Notary Public-State of Florida) (Si re kif Notary Pu lid-State of Flo i a)
Personally Known OR Produced Identification ✓ Personally Known V OR Produced Id nt' is
Type of Identification Produced Q, tr�'� Type of Id t f1catior�P.;u
YNOLUb
Commission No. .'P••., K' I SHANNON C R tf
"""' Mp,R{(Filt9gK1�0 Commissior2 No:. Pubiic -StatFg Ipr0
.; '__ Commission#EE 140704 i ''•'=M Comm.Expires Sep 1,2018
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Expires October 23,2095 y mission Ff 9511>t8
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Revised 07/15/20
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