HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 A/
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 IMFROVE��MENT LOCATpION - j ,
Address:
Legal Description: 3C— C40 S iITei4 k':�4c2TW 1EI7fZ_"tYr ZA%
g@.0--CAM �.O i..&C�2. S J114 ° -r/-t41,32.'r4€�t vj. 11463,2 t POB
Property Tax ID#: ? c,vv'� Lot No.
Site Plan Name: Block No.
Project Name: .D acL�L�=e
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPT[ON O`F WORK
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CONSTRUCTIOiv INFORMATION f
Additional work toe e orme under this permit—c ec a app y:
HVAC E]Gas Tankas Piping _Shutters Windows/Doors
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[]Electric Plumbing E]Sprinklers Generator Roof
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction: $ " L)' Utilities:T]Sewer 0Septic Building Height:
OWNER/LESSEE CONTRACTOR _ t
Name 19 C j c !e, r qzi .o A j?& Name: Q C
Address: �zc� . Company:
3a
City: %,. �, �+ Stater Address: -71(-)( i "('c, � C
Zip Code;-,-&'99 Fax: City: State:
Phone No. 4 62 t?3,:�J Zip Code:-3 4 S rr Fax: q62 —D1_'? 2—
E-Mail: Phone No.
Fill in fee simple Title Holder on next page( if different E-Mail:_ \�;�c lniA owrrr c lv .w
from the Owner listed above) State or County License: 9C,:>0C.(.-7&9
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INE(JRMATION+
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.
s
_Sig lure of Owner/Lessee/Agent Sign ure of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF J s� COUNTY OF �Sk. UP _
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this_day of 1-M 2014—by this 3 day of IAV 1-20 _)�_by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public--State of Florida ) (Signature of Notary Public-State f Florida)
Personally Known �� OR Produced Identification Personally Known �NG--
typeT e of Identification Produced , . � Type of Identification Pro cel"�'�:�., LA to of Florida
tRn s,a 9nrre at.
a°♦ #���ta'Y ' —1
NGFA �; My m Expires Dec 20,2018
Commission No. • �ASHi(g� J�ate of Florida Commission No. - �� sion#FF 1'I 249
4 PU to Public- 2U 2018 `� �'� hrou h National Notary Pssn.
NO r m ,Expires Dec 2 .1j BOn;1rA V 9 r
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M, V issio Comm %otaryRevised 07/15/ •�' Bonded�hr° 9
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