HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED h_
Date: Permit Number: �✓ �CX" 011 U
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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
Address: w R 9AP
Legal Description: V --)A S
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Property Tax ID#: ;),�Orl-8o1- OCOa - ow- Lot No.
Site Plan Name: Block No.
Project Name:50_,7� e, _NIMS
Setbacks Front Back: Right Side: Left Side:
t; x l a s��
D AILED DESCRIPTIONUFWORK' u � a� $ '
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CONSTRUCTION INFC?WN
RMfA�TION d rxl
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Adclitional worK toe e orme under this perms -c ec a appy:
❑HVAC Ei Gas Tank Gas Piping _Shutters ❑Windows/Doors
11 Electric 19—Plumbing Sprinklers 1:1 Generator F] Roof
Total Sq. Ft of Construction: S . Ft. of First Floor:
O�
Cost of Construction:$ Deww.co Utilities:nSewer Septic Building Height:
4 a 00` a s hyrb 'ter fft M f z e
OWNER/LESS: E' � .. ,r,, r..., :CONTRACTOR
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Name � Name: \__TCJhrn 'VA. IjbWet,r)
Address: Aku) t T c Company: IO SCC
City:_20ft �t- Woe- State:, Address: il',� 2
Zip Code: N9 19"U Fax: tea- tel' 6202- City: 4YInlnul)o Stater
Phone No. 17d- &n- 52JO Zip Code: 9,; Fax: 41II'y71
E-Mail: Phone No. 141- 14714- q3W
Fill in fee simple Title Holder on next page(if different E-Mail: —tfmit ySIY ��OYIVZ&ryi(e.(M
from the Owner listed above) state or County License: ✓ CPCI115Uy-1-7
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
.SUPPLEMENTAL-CONSTRUCTION LIEN LAW INFORM&Id is
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:
1 certify that no work or installation has commenced prim 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.
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_signature 01
0 er Lessee/Agent igna a of Contractor/License Holder
STATE OF FLORIi,,,,, n ` STATE OF FLO DA
COUNTY OF ��1 w COUNTY OF X�QUn
The for oing Instrument was acknowledged before m The forgoing instrument was acknowledged before me
this day of INOQJM)Qg&�, 20 15by this day of M)Q& .20 A5 by
(Name of person acknowledgin& (Name of person acknowledging)
A NA
C
(Sign211y
re of Notary Pub is-State of Flo da) (Sig ture of Notary Public-State orida)
Perso Known.�OR Produced Identification Pers ally Known V OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. "
.• ., Ommission No. "gip• ea
°B J
,e<P.... a4 JULIE MCGONIGA E MC:GOPlIG
_�, :� UL
MY COMMISSION#FF070 8
N'. es v�
""�oF�oa EXPIRES November 14,2017 "'?'oFo?i .EXPIRES November 14,20
17
Revised 07/15/201
(407)398-0153 FloridallotaryService.com (407)398-0153 FloridallotaryService.com
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