HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
III`
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 Zi_
PERMIT APPLICATION FOR:
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PROPOSED IMPROVEMENT LOCATION Y
Address:
Legal Description: WpINQaK)"'At 6 AA '�\
1 — — `
PropertyTax I D#: �/ (�C} nil k—cnn Lot No. I
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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DETAILED"DESC RIPTION OF WORK s v
CONSTRU:CTIONr, WORMATION -{ s
Additional work to BBe pefformecT under this permit—Check k a that app y:
_HVAC _Gas Tank —Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ Utilities: —Sewer _Septic Building Height:
°OWNER/LESSEE ';, ' °;CONI"RACTOR
Name Name e
Address: 2 t2 Company:
City: ( State: _ Address:1173/An be m 0
e
Zip COL: `Z Fax: / City: CSN State:
Phone No. ��—`—Z 1 �j ( Zip Code: Fax:
E-Mail: Phone No. Z. C 2.
Fill in fee simple Title Holder on next page(if different E-Mail: iv t
from the Owner listed above) State or County License: C 1z.C. 1 s 215 p 2
LIf value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUP'PLEM-ENTAL 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.
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_Sig ati re of Owner Les nt Sign re of tontractorf
Li er
STATE OF FLORIDA STATE OF FLORI A
COUNTY OF 6 COUNTY OF 5 y(�,"� e
The forgq�g instrum nt was acknowledged before me The forgping instrum nt was acknowledged before me
this p day of (0P— 201f2' by this(2�day of O'ka, 2015 by
(Name of person acknowledging) ( ame of person a knowledging)
(Signature of Notary��OR
ate of Florida ) (Signature of Notary lic- tate of Florida)
Personally Known Pr d ced Identification Personally Known OR Produced Identification
Type of Identificatio roe ucg �,� „�, ,,,,,,�, Type of Identification Pro ce
.`tiPR FUBl��. R N 6���� Ivin
Notary Public-State of FBE tA ttJ2 MASCO
lorida . Not,ry-P�plic-Stat:fF idaCommission No y Com(r5.fR0ires.Nov 1,2016 Commission No. .N* � • My a Expires 016Commission#EE 848616 ;;F c Commission#E
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Revised 07/15/2014
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DATE
COMPLETE
INITIALS