HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application DEC 2 9 201
Planning and Development Services PERMITTING
Building and Code Regulation Division St. Laacie Courlty, FL
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
I
PROPO_SE®,INIPROVEMENT LOCATION.`:._
Address: C4,CA
Legal Description:
Property Tax ID#: 13v6 f G / o o lg 1 0 0 d oy Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTIOROF WORK
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CONSTRUCTION INFORMATION
Additional wor to flGasTank
orme under this permit-check a y
app :
HVAC ®Gas Piping _Shutters Windows/Doors
®Electric ®Plumbing Sprinklers Generator ®Roof
Total Sq.Ft of Construction: S .Ft.of First Floor.
Cost of Construction:$
Utilities. Septic Building Height:
OWNER/LESSEE ;; .CpNTRACTOR:,
Name Name: c. n ill C
Address: f Company: ��c lil �' / (M-/1�L
City: TU State:_ Address: �ica3 ,Erkce .(c
Zip Code: 3, Falmr �
City: f !'i ds State: /
Phone No. l d l `GZip Code:J ��U Fax: 7 a ��r`o`r�`!f7
E-Mail: Phone No.!
Fill in fee simple Title Holder on next page(if different E-Mail: ce,/ P CJ
from the Owner listed abode) State or Coun License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
'UPPLEMEi �A!-CONS3RUC-DON , EI11 LAW f-1 11F�91tIVIAT{0N _
DESIGNERANGINEER: 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: Rhone: Tip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit
St Lucie Co�makes no representation that is granting.a permit will authorize the permit holderto build the subjectstructure
which is in conflict with arty applicable Home Owners Asso&don rales,bylaws or and covenants that may restrict or prohibit such
structure.Please consult vM 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 Corley and St Lueie County Amendments
The following building permit applications are exemptfrom undergoing a full cornxarrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and acoessory uses to another nwrieddential 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
-commerliring work or recording our Notice-of Commencemen
ignature of Owner/Lessee/Agent Siallature of CEntr-actorllicense Holder
STATE OF FLORIDA STATE OF FLORID
COUNTY OF COUNTY OF AS LIAr s4
The forgoing ins�rment was acknowledged before me The omg friskTument was acknowledged before me_
th"�clay of j,2,�.. , zo �S by th" da3► 2D 1*
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary PubTie tate of Florida) - - a e of Notary Public a of Florida}
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
a,,.,,, (ASHANNA
Commission No. (Seal) Commission No �Y nU'o,
Notar PUblir - ate ]Assni
My Comm t,om!: Dec
LASMAHNAINGRAM
Revised 07/15/201 ` ? �;` -. Notary Public-State of Florida a�F`��,` BondUl conal Ni '«tinsy�
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--h-1/Comm.Expires Dec 20,2018
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