HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 7 U�I l ��S Permit Number:
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 arrow at the end of line
PROPOSED IMPROVEMENTLOCATIQN:
Address: E iTr?� hEurn
Legal Description: vt,' G'
Property Tax ID#: 3�/ ►y56 r i' 7e Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OFnWORK
ear G� r �✓lr �t/I�J �� /�' - 3��0'1
CONSTRUCTION INFORMATION
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Additional work to be performed under t is
permit-cneCK all appy:
HVAC Gas Tank ❑Gas Piping _Shutters ❑,Windows/Doors
OElectric Plumbing Sprinklers OGenerator Roof
Total Sq. Ft of Construction: Afllo S . Ft.of First Floor: 010'VCost of Construction:$ l U Utilities:ll Sewer FiSeptic Building Height:
OWNER/LESSEE CONTRACTOR:
Name A Name: Rr%ah P4 d
Address: 51 a.r f � t yl ed" Company: cL rc/r
City: 9,r+-.S,;vL Lve,a State: Address: )F/Z .SL/ R.'116wire,
Zip Code:` �2 Fax: City: Tor r-::J .'..t we"d Stater
Phone No. Zip Code:W41Y Fax: 77,?-3y3- 735,
E-Mail: Phone No. -7707'37e)_ 76)
Fill in fee simple Title Holder on next page(if different E-Mail: ' -e J� v—RL:✓ L L ea o,n
from the Owner listed above) State or County License: ee G 33 ee5 3
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 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.
,��`` ` � , %fir,_ 2
s
_Signature of O ner/Lessee/Ag Signature of Contra License Hold
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF .S,'c - lve,'d, COUNTY OF �:✓L�
The for oing instrument vyas acknowledged before me The for oing instrume� as acknowledged before me
this J� day of Oc a r 20 Eby this T day of la r 20 J-5 by
(Name of person ackn ing) (Name of person ackno ging)
(Signature o otary Public-State of Florida) (Signature ,Pu lic-State of Florida)
Personally Known OR Produced Identi fiVO'A1Illy���.. Personally Known _\/ OR Produced Identification
Type of Identification Produced I ........ Type of Identification Produced ��1ti�419=Iilll///
e .•� t�ISSIrpF�F ......° U�%ys
Commission No. �,• c, 12, / % •
mal aY 20 0� commission No. a�^'�,
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Revised 07/15/2014 9•:g ended lhN. s•e o�� o• #FF 122434
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DATE
COMPLETE
INITIALS