HomeMy WebLinkAboutBuilding Permit Application All APPLICAB�E INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: l ! 1 Permit Number:
m s
w , 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:
PRaP- SED (NPRO.VEMENT LOCATION„ '
Address: 3 S 31 5 A-ND L-4CC GOVi27 PS L i / vq512-
Legal Description: 8L40CK G — LO-F /D D!R ( L/I 2. 2.5 3 j
'RC 5&-P--U 6' C A- p'WA1 A C'c vg
Property Tax ID#: 0 Lot No.
Site Plan Name: Block No. SZ
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPT
C � ION OF5 WORK W
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CONSTRUCTION INFORIUTATI' N
x
Additional work to be performed under this permit-check all that appy:
—Mechanical _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:$ l (�U '�y Utilities: _Sewer _Septic Building Height:
8KLESS _CONTRA�CTORx
aux S .
Name L' lL(� Name:
Address `3 �l�`IJ� G[ cCJf?j- Company-,(; CU , ,,�-�rG2CT/�l
i n ! 64
City: L. Stater Address: -" 7
Zip Code. 3 52— Fax: City: T- `sd/ems State: �
Phone No. =�� -60V312,135-73Z,5' Zip Code: 37"t931 Fax:
E-Mail: Phone No 77a - 30-3 --!5j-5-
Fill in fee simple Title Holder on next page (if different E-Mail ee e C cC-CPE
from the Owner listed above) State or County License De- 1301 443 6 6
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SU PP LEMENT,AL"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:
OWNER/CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do 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 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 the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing wor or recording our Notice of Commencement.
rL� GCJGc� 7
Signat a of Owner/Lessee/Agent Signa t e f Contractor/License Holder
STA OF FLORID STATE OF FLORIDA f
COUNTY OF LUCC_`E_— COUNTY OF
The fgrf�oing instru nt was acknowledged ore me The f rgoing instru t was acknowledged a me
this 1 day of e� 20-ID this r day of 20 by
�® aLn n L)
(Name of person acknowledging) (Name of person acknowledging)
CA4/Vr1J �AAI
S'- re of N ry Public-State of Florida ) (Si Notary P lic-State of Florida )
Personally K o n R r n' Personally Kno n OR Produced Identification
_JMe o �n,,,, ANGELA M HUFF Type of Identifi to
Produced .•'��� B%'=, NotaryPublic-state of Florida ro uced ,-•o� "�o'�- ANGELA M HUFF
•; :•e Commissidh A�FF 234730
Z.• •: °ary Public-State of Florida
Commission b;, �P;= M Comm.Expires ,2019 - Commission %21#730
y ► 7j Commission No •Ps +r(
BondedthrouyhNowdNotaryAssn. - °F„o••.• M.Expires May 27.2019
Bonded through National Not assn
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DATE
RECEIVED
DATE
COMPLETED
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