HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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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
PRO PO5ED IIUIPROVEMENT LOCATfQN
Address: I oip�4 WS (�G(�1a?,.I A7- I -ibsKEW -13L-AC4 n—
Legal Description: hil N S �'� '''�� f}"yIT 1 Oy"7 ( o✓L I&C3- ( vi b
Property Tax ID#: 90q - (9J7 rj -abr-2- Lot No.
Site Plan Name: 12 . e;CVL- Block No.
Project Name: ,� Iy I
Setbacks Front f,/ ' Back: Right Side:_ _Left Side:
DETAILED DEQ RIPI"IONXOF WORK
W,NoovI aa f Pl�►�na� wl s �-r S
CONSTRUCTIC3N INFORMATION �4a �'
Additional work toe e orme under this permit-c ec a appy:
❑HVAC E]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:$ 1210,)Q Utilities:0_Sewer ElSeptic Building Height:
OWNER/LESSEE CONTRACTOR
4.
Name. C►2 ei L' 4 C l- Name:
Address: I GO L/q S C3c.taiv 13k , 4�- I OU-7 Company:-],'N� �Sc-�Fti� �l�•t,N'�l��
City: State: Address: 17Zo kW
Zip Code: Fax: City: '{yState
Phone No. 0?.2� - dr`/� Zip Code: g LtCr r?h Fax: (09z -q7'-ol
E-Mail: Phone No. 6 G, U9
Fill in fee simple Title Holder on next page(if different E-Mail: /L1/�/ C.Guo Owen d J
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LA11U 1NFC3RMATIQN A fz.'
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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 OWN R:Your failure to Record a Notice of Commencement may result in�osrted
upaying twice for
improvements toy ur rop rty.A Notice of Commencement must be recor ed d on the jobsite
before th first in pec "on. f y intend to obtain financing, consult ith I d r ttorney before
comme n wo k or our Notice of Commencement.
A5- r�
s
Sig ature of ner/LJAR
Agent S' nat re of Cont acto / ice a Holder
STATE OF FLORIDA �'P STATE OF FLORIDA C
COUNTY OF //AI COUNTY OF
The f r oing instr nt wa acknowledged,�efore me The f rgoing instr ent w s acknowledged before me
thi da ofu•. � 205 by thi d of !r 20 A by
% Ctek dcoJ�dl ,
/ e`7i GJrsJ
(Na e o p acknowled i (Name perso cknowledging)
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jPersontal,y
re of Notary Publ' -State o3,da) (Signature of Notary Publi State of Flor'Known OR Proddentification Personally Known OR Produced
entificattiiioon Produced Type of I entificattiion Produced
Commission No./ Commission No.// (Seal)
JOHN LEE TINNEY
;o• a,'•. 0.,kllcState ,•�para�.,, JOHN LEE TINNEY
My Comm.Expires Nov 15,2018 =?• Notary Public-State of Florida
Revised 07/15/20 9, P Commission #FF 165316 �=My Comm.Expires Nov 15,2018
Bonded through National Notary Assn. "-�F op�O.•'
Commission FF 165316
Son e row National No Assn.
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