HomeMy WebLinkAboutBuilding Permit Application JUN-17-2011 15:17 From: To:7724621578 Pa9e:1/4
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
MOP Permit Number: V oa V(p
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Building Permit Application
Planning and Development Services SEP 11 20 E5
Building and Cade Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Address: T- lace Lave. I
Legal Description:
Property Tax ID P#: 1312- — �-_,&Q :2-- 0� Lot No.
Site Plan Name: Block No.
Project Name: V
Setbacks Front Back: Right Side: Left Side:
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itiona work to e e Orme un ert isperm� —c ec a appy:
®HVAC Gas Tank ❑Gas Piping _Shutters ]Windows boors
[]Electric 171PlumbingSprinklers Generator 1-1 Roof
Total Sq.Ft of Construction: 5Ft.of.FirstFlFlo`�or,
Cost of Construction:$ \ 1' L. Utilities:iSewer FISeptic Building Height:
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Name Name:
Address: ► 22.4 �hti(k-S P&(t1,-W 1C 1)a Company: � 1r�1�•S ��c�t1[�il;t~n�:t_ 4�
City: okln ___ State:. Address: I R rk.k_-$
Zip Code: 2 6�A Fax: City: 4t Ck4_Cx•6\ State: IF L
Phone No. _0 }2) =} UdCAc3 Zip Code: 33`13 Fax:
E-mail: Phone No. ie_)92,k4 2t-JI
Fill in fee simple Title Holder on next page(if different E-Mail: C~i,,1k%2S . 'i f ,`
from the Owner listed above) State or County License: l6 j3L-95 S ._
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
JUN-17-2811 15:17 From: T'v:7724621578 Payc:214
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: NotApplicable
Name: Name:
Address: Address:
City: State: City: State:
Zip- Phone: Zip: Phone:
FEE SIMPLE TITLEHOLDER; _NotApplicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City, City:
Zip: Phone: Zip: Phone:
I certify that no work or installation has commenced priorto the issuance of apermit.
St.Lucie County makes no representation that is granting a permit will authorize the ermit holder to build the subject structure
which is in conflict with-any applicable Home Owners Association rules,bylaws or anicovenants 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 r attorney before
commencing work or rec9TAg Your Notice of Commencement. '�J
Signature of 0 e gent Signature of Cont r se Holder
STATE OF FLORID STATE OF FLORI
,trument was acknowledged before me The forgoing instrument was acknowledged before me
The forgoing ins
k 20 �Ex_by this IC day of
(Name of person acknowle gi (Name of person acknowfe
(Signature of Notary ruli,4�ffte of Florida) (Signature of No4tary - ate of Flriid,
Personally Known OR Produced Identification Personally Known OR Produced identification
Type of Identification Pr Type of identification Produc
MY commission NOIC�:-Ic-,ic-2AP, 1
EX 21RE August 14,2018
-3 Auatist 14
(407)398-01 Sa FlondallotaqService.com
Revised 07/15/2014
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