HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: ISl I
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:
PROPOSED IMPROVEMENT LOCATION: .
Address: '779-7 76A,
S I
Legal Description:
PS 1333 4 - >2,3 -00o j To
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION 0'F WORK:
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CONSTRUCTION INFORMATION:
Additional work to be pertormed under this permit–check all tat appy:
AC _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: $ 2��' Utilities: —Sewer -Septic Building Height:
OWNERAESSEE: CONTRACT R:
Name PO
4�5& e Name:A ZW
Address: J VU 11 L Company:
City: Ldfi State: Address: z
Ace-
Zip Code: Fax: City: lie 5=� L(/L) I State:
Phone No. Zip Code: 319T3 Fax::
E-Mail: Phone No. 77,'q71-,117 1
Fill in,fee simple Title Holder on next page(if different E-Mail: ?I-&- A0l otyh
from the Owner listed above) State or County License: '��jCx}3Z`�
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. �1
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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 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 t first 'inspection. If you intend to obtain financing, consult ith lender or an attorney before
Corr in k or recording our Notice of Commenceme
S
gnatur of Owner/Lessee/Agent Sig re of Contractor/License Holder
TATE OF FLORIDA � u�� COUNTTE OF FL
Y OFORID -
COUNTY OF
The for o' g instr a was acknowledged 0fore me The forgoing instru ent was acknowledged Wore me
this ay of 2%by this `� day 20 lS by
me of p son acknowledging) ( of person acknowle g _
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Pro u d d ntification li Personally Known OR Pr d ced Id t'figotlon c..
"�� Type of Identification Produced y -
Type of Identification Pro�luceT, �� YP 1 : '
:Pa°.P . ? ��y Comm.Expires Mar 22,2017
r° d`�= f��arryy Ppblicp—State of Florida,
Commission No. s fi�. f hal Commission No. -- ,�:. Comn(iS®el)#EE 877571
_ M Expires Mar 22,2017
C=•.T. Bonded Through National Notary As a.
Commission#.EE 877571 9 Y
;4911911 N.I.I.-nal NoIaF!
Revised 07/15/2014
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DATE
COMPLETE
INITIALS