HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABL INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: L Permit Number: ���7�— 01 I
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Building Permit Application 'DEC
15 Z015
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
PROPOSED IMPROVE MENT.LOCATION:` -
Address: r�.� "��► 'iC� /lA-t G -26-7G C��� J � —,eC�— r° .2
Legal Description: G�Ti4 S �eL �G�lJlJ�i2 Get uM�
Property Tax ID#: �.�.� .S�C�� t1�6� G�j®2- Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back:6�Right Side:, 1 Left Side:
-DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
Additional work toe nertormed under this permit—check a app y:
HVAC Gas Tank Gas Piping _Shutters ZWindows/Doors
Electric ❑ Plumbing Sprinklers ❑Generator _El Roof
Total Sq.Ft of Construction: SQ. Ft.of First Floor:
Cost of Construction:$ �/ 7, Utilities: _Sewer❑Septic Building Height:
OWNER/LESSEE: !CONTRACTOR: i�D
Name Name: /W-2 ?7�erIOtLKUhL0940
Address: /,9 Z,_1,jCAdZ "671-7/1.4'�Z Company:
City: A6u zw .r7—, �/i�E�- State: Address 3
Zip Code: 'S Fax: City: State: =_-
Phone No. Zip Code: 34195_ Fax: 772 33.6
E-Mail: Phone No.(77.2/ —at C
Fill in fee simple.Title Bolder on next page(if different E-Mail:o 9 I_tzA1g_ cl-"
from the Owner listed above) State or ounty License: 24zz 2.
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
.SUPPLEMENTALCONSTRUCTION LIENIAW 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 the first inspection. If you intend to obtain financing,consult with lender or an attorney before
commenwig work or recoyjding Vour Notice of Commencement.
S' nature of Owner/�AW' nt/Lessee Si ature of Contracto 'cense Holder
STATE OF FLORIDA • STATE OF FLORIDA A
COUNTY OF � �Q,f _Q1 COUNTY OF
The f� ing instrument was acknowledged, be re me The forgoing instrume t as acknowledged before me
this ITday of�,�_{ / 20 y this I C Iday of Lb
20
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(Na e o erson acknowledgin ) (Name of person acknowledging)
ry blic-State of Florida) f Not Public-State of Florida
Persona_Ily Known OR Produced Identification :I( AM ed I,oentification
Type fi ti Pr duced Omits WE) � f
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Re a through National Notary Assn .
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