HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE I O MUST PE COMPLETED FOR APPLICATION TO BE ACCEPTED ( J
Date:--,),t Permit Number:
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
PROPOSED IMPROVEMENT LOCATIO"N
Address: -7'�70 S (ngg* Z44,1G5 JR- 1 -rewe- q
Legal Description: Jajajx I, !,
Property Tax ID#: 2iS�Z•Z �c�Z —010 — 05:1Y2 Lot No.
Site Plan Name: r—_0 14M 4'A-" Block No.
Project Name: Mn4-�J
Setbacks Front Back: _Right Side: 7 — Left Side: X,
DETAILED DESCRIPTION OFWORK
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CONSTRUCTION tNFORIVIATION
Additional work toe performed under this permit—check appy: _
HVAC Gas Tank ❑Gas Piping _Shutters Windows/Doors
❑Electric ❑ Plumbing Sprinklers Generator _Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction:$ �0000 ' Utilities: Sewer —Septic Building Height:
0.1NNER/LESSEE ONTRACTOR
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Name Name: /G Y
Address: any: ,4hf4V AfIX/ ti
City: _ s: 17 My /�l7C L•
Zip Code: Ci V.
s / State:�2
Phone No. g S`L �" l 2 Code: 2K Fax:
E-Mail: Phone No. �O`I2 009c
Fill in fee simple Title Holder on next page(if different E-Mail: /Ae--,V;Mt e,&aa;4,v N+//go "ti%
from the Owner listed above) State or County License:�G t'�b �( 3 ,
If value of construction is$2500 or more,,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFQRMATION '
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 pos ed on the jobsite
before the first i spec 'on you intend to obtain financing, consult wit lende o an torney before
comme I rk o re ng yourNotice gif Commencement.
Jop
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igna e o wrier/Less / gen Signature of Contractor License o er
STATE OF FLORIDA STATE OF FLORIDA ,�,
COUNTY OF , �� COUNTY OF 71d
The f r%ng instru �e t was acknowledged before me The forgo fg instru n /w�,aAs acknowledged before me
thiay of L'�2/Jl2.3 20 11�by thi�aay of �!!( 20 l by
Adl.i'a,
(Na a of person nowledging) (Name f Orso knowledging)
( ignature o Notary Pub' -State of Florid (Signature f Notary Publi tate ofncL
Per onally Kown 0 P c I 'fi tin Personal[ nown 0 Pr d fication
Type d tification Produc �t'����„e ,,,,,•,,«EE t,,,,,�y dentificati P`APcawoC
Notary Public-State of I i =_;• *`�i
No P is-II$tate of Florida
Commission No. ' :(5 )Comm.Expires Nov.6
ission No. _ •=My CommrQs Nov 15,2018
Commission#FF 165 16 fF °:'- Commission#FF 165316
,,OF i�•• ii OF Fl••��
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Revised 07/15/2014
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