HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE_ INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number.
RECEOVED
fi} Building Permit Application
Planning and Development Services No� ' 6 20'8
Building and Code Regulation Division
2340 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
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Address:
Legal Description:
Property Tax ID#: LI'S 11- SZ-Q` moo I+�I o - coo �(') Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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C i��TRUC 22�Zli lfLl� s �TlQ1Y �C='i` ��,x�*`�s � Yc�•}'s`��`� �.�N'�`` S ��'r`•?'_'�,r���f?yfi�*2 ,? $l1. r y„�-:l ,Jx_t< t r 'a ,a..
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itiona wor to e e orme un ert is permit—c ec. a appy:.
.HVAC �Gas Tank QGas Piping _5hutters �Windows/Doors
Electric 0 Plumbing Sprinklers Generator a Roof
Total Sq.Ft of Construction: Sq.Ft,of First:Floor:_
Cost of Construction:$ 9 it �(�JPb Utilities: Sewer❑Septic Building Height:
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Name\(ice lI \'��f' Q ( Name: LLt �Ct.( -c-r
Address: � .�.'`i_ eb; Company: bC�5lf..l'� ��� �' �c�aCL Lel
City: C� G 11. State: F Address: �'1 b, C-)& tho
Zip Code:323 0 Fax: `fb'.- Lr10 1535 City: 3M<ieA i 4c—h Stater
Phone No. bpi- U� ` Z t1.1� Zip Code: Fax: 72-- 3 y124
E-Mail: Phone No.. ._TTH
Fill in fee simple Title Holder on next page(if different E-Mail: 60--LL IcRb<y CL-ai w
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencementis required.
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OCS1aiyE /EhIGIIVEER: __Not Applicable 9VIORYGAGIE CiNaPAiiB'Y'� N:ot Applicable
Naive• Name:
Address: Address:
City State: City. State-
. ,
Zip: , Phone: Zi
p: .Phone:
FEE SIMPLE TITLE HOLDER: __ Not Applicable BGNDING-00MPANY: —Not Applicable
Name: Mame:
Address: Address:
City, City:
Zip: Phone: Zip: Phone:. _
I certify that no work or installation has commented prior to the issuance of a permit.
St.Lucie County makes no representation that is granting a permit will authorize the permit ho#derto build the subject structure
which is in conflict with any.applicable Home Owners Assoctatiori rules,bylaws ot'andl covenants:that miay restrict or prohibit such
structure.Please consult with your Home Owners.Association and review your deed for any restrict#Ons which may apply.
In consideration of the granting of this requested permit,I do:hereby agree:,that:#willjuall respects,.perform the work
in accordance-withthe approved plans,the Florida Building Codes and St.Lucie CountyAmendments.
The following building.permit applications are exempt from undergoing a full concurrency feview:room additions;
accessory structures,swimming pools,fences,.walls,signs,screen rooms and accessory:uses to another non-residential use
ARNING:TO`OWNER:Your failure to Record a Notice of Commence May result in your paying twice for
improvements to your property.A.Notice of Commencement mus t°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.
Sign ner/Lessee/Agent S#gn o antractor/License'Holder
STATE OF FLORIDA 1 STA17EOF FLORIDA
COUNTY OF ��Cti`�1. � COUINTY OF
The forgoing instrument was aekowtedged before me The forgoing;instrument was`acknowledged before me
this j i<?°day of trd l l• 1 � 2{3 Ebythis day,of 20 6y
Lye
(Name of person acknowledging) (Name of person acknowledging}
• - ~�.r"-� .. �+,ei.,,.....r :. ,:'. r..._. Jia :._
(Signature o otary Public-State of Florida} (Signatu re of otary Pub#ie-State of Florida}
Personally Known r/, OR Produced Identification Personally Known ...OR Produced Identification
Type of identification"Produced',•,, Type of IdentificationProduced . . ...
yr,4iH .JOY D'ADAMS _ ADAMS
Commission
1110. :° Gomm(i eal} #FF 907740 Commission No' Oat.aari. 1� aq
a COMMissl0n N FF 907740
.. or My Commission Expires
M Commission Expires
•.,�*�, Jonuar. I4. 2017 a. v
Revised 07/15/20,14
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