HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: � �. �J Permit Number:
9
RECEIVED
Building Permit Application OCT
Planning and Development Services z 2205
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: % Ioe
PROP 5ED INPFR01lEMENT LOCATION / �,--y�
Address: IS "r-uc-e �Q r-74 ,/",� •,e r-ce 3 /9 S1 �IL-
Legal Description:
Property Tax ID# 3�Go� (D/O Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILEQ QESCRIPTC►N UF,WORK
�P /�� d ��`� �y a•Ci � ziz lzz 46ul 'Ode�.
CONS TRUO
GTIONINFRMATION
>sa _ .. .... .
itiona work to be performed under this permit—check a .t at.a,pp y:
_Mechanical _Gas Tank —Gas Piping Shutters _Windows/Doors
—f
Electric —Plumbing —Sprinklersf ; ;Generator _Roof
Total Sq.ft of Construction: ® /pZ, Sq.:Ft..of First Floor:
Cost of Construction:$ West 00 ® Utilities `Sewer —Septic Building Height:
N a me
Name:_` J R IA—
Address: Company:_ SLS
City: rel Q--- toii--rc:C State:F Address: /A)
Zip Code: 34/9, Fax: City: 163d:: A�erc e_ State:��
Phone No. Zip Code: _k?!Yq Sf D_ Fax:
E-Mail: Phone No sr5 2 6
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTALYCONSTRUCTION LIEN LAW`INFORMATION
DESIGNER/ENGINEER:a _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:
OWNER/CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit tomo the work and installation as indicated.
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 thepermit 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.
(�(I ri k_�A , - e rLl,)�, t,
Sign ure of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORID�2" STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instr ment was acknowledged before me The forgoing instrAiment was acknowledged before me
thi�Z day of 20LT-by _ thisQ3day o 20�, by
a.ek-je
:1... �..
(Name of person acknowledging) (Name of person acknowledging
a l
2 m5.m � ,
(Signature of NOAry Public-State of Flo ida) z (Signature ofary Public-State o,#;Fl rids ) o=
III Personally Known �� OR Produced Identificati T" Personally Known. V OR Produced IdentType of Identification Type of IdentificationProduced "' ProducedCommission No. (Seal) Commission No. (Se
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