HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED I,�
Date: PermitNumber:
•
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 —V
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
rPROPOSEDxIM'PR�VEMENT L0CATIt3N4
Address: .S `"'G ea./7 C ke-
Legal Description: 9,l uck, Ica -q.1::: U/V;f
Property Tax ID#: Lot No.
Site Plan Name:�.r lr, � Block No.
Project Name: G'04 -A[e ��C.�G If,
Setbacks Front Back: Right Side: Left Side:
DETAILED'DESCRIPTION OF WORK r s
, s f� 6 ' �/h 7 Svc- v'"'� ;1°A c�
104-0PICa-� /vT,�G Fwd���� - ���s o�vt
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CONSTRUCTION INFORMATION_
Additional work toe e orme un er t is permit-c ec'xal appy:
HVAC Ei Gas Tank ❑Gas Piping 1:1_Shutters Q Windows/ oors
Electric 0 Plumbing Sprinklers I Generator E] R Rf G
Total Ft of Construction: l,r6L�— S . Ft.of First Floor:
Cost of Construction:$ - 12 V Utilities:Sewer F]Septic Building Height:
OWNER/ ESSEE - "f za CONTRACTOR
Name '' Name: e-kce-(
Address: 3 �v� �-�G P�'" Company: ye+cra,,-S,
City: L_ State: rLs Address: 7--foo-e- b—) Aife.
Zip Code:3Lt Q rt 3 Fax:. City: 'Ps L
State:I'�-
Phone.No.>) o�, ':�'7 C( Zip Code: 3`r�1�3 Fax:'1?Z-919-/00 9
E-Mail: Phone No.112-607 '- 2,3S$
Fill in fee simple Title Holder on next page(if different E-Mail: ?ca7 e,a l Cie-rrvt ar'.(f�(Q TO o,Co A,%
from the Owner listed above) State or County License: 6&- Oj �3
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL 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:
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 work
/or recording our Notice of Commencement.
s
Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORIDA � STATE OF FLORIDA
COUNTY OF (r ,Lv C. I COUNTY OF ,5 f 1 G L -�
Thefor oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of^ 20 I-C-by this 57 day of 14 ✓i3 20 L by
M �7�c
(Name of perso acknowledgin (Name of person acknowledging)
141,9t—
(Signatu
a of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
RersQaaHWX nownOR Produced Identification n OR Produced Identification
Type of Identificati Pdu
roced Type of Identification Produced
Commission No. ¢ (SealkIRK ARI KATZ o mission No. VIqil
MY COMMISSION#FF = �• KIRK ARI KATZ
A ii4
24 :.;
oFF� ugust 12,2017 °•,,,� o
407)390.0153
Floridallota S '!oF,�;P' EXPIRES August 12,2017
Revised 07/15/2014 ry ervice.com 1(407)3911-0153 FloridallotaryServlce.com
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