HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ermit Number: i6d -Ib
RECEI D FEB 2 3 246
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
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Property Tax ID#:3qoe� _700yo-ox Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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6,
71"M
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Additional work to be nerformed underthis permit-check all that apply?
11 HVAC Shutters
11 Gas Tank []Gas Piping 121windows/g9ors-
F]Electric 0 Plumbing LISprinklers Generator Roof
Total So. Ft of Construction:
S Ft.of First Floor:
Cost of Construction:$r2 3 0 "3 Utilities: Sewer Septic Building Height:
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Name-Y)hv)f) Name::�, i
Address: llwt Wm-elfo D7.— Company:-:F-L-(o..
City: i5l , Pipa'-f State:E(_- Address:
SH (0 1 _75 T+1
Zip Code: Fax: City: [A),_ffi Q-.nom, -State: Y:I-
Phone No.-:2_2
Zip Code:3SLI I Q�-- Fax: 5-L.,l
E-Mail: Phone No. 5—LA/- 'S' 4-1 Gid
Fill in fee simple Title Holder on next page if different E-Mail:
1>Y40, Pernis L-,VVA-
from the Owner listed above) State or County License: C62 0
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTA '�CdNS�RUCTI;ON�LI'EN,LP►W�INFORi,11JIATIONi.', .' �.: ;,;�� jy�,�'�;��.'u. � ; ���'�; � •��,`��
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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 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,
_Signa - o Ow r/LesseeTAgent
Signature of Contractor/License Holder
STATE OF FLORIDA . STATE OF FLORWA j
COUNTY OF �, COUNTY OF_ (�!j QPCIq
The forgoing instrument was acknowledged before me The forgoing instrunt was acknowledged efore me
this I day of _ � Lc
� 20 aby this a2
�b &ay of_t b, 20 ( by
(Name of person acknowledging) (Name of person acknowledging)
kigRgture of Notary Public=Sidi of Florida)_7 Signature o otary ublic-Sta of Florida;----- -- )
_ _.__ _ _ _�, _
Personally Known OR Produced Identification Personally Known L--""'OR Produced Identification
Type of IdentifEca !-�o uec - — ANG Type of Identification Produced
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""" LASHAHNA INGI M
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Commission No. "r +`r: Notary Pu�60 e8'tate of Florida Commission No: n� r.�°gi, ANCELAvaur eai)
__'• e•_My Comm.Expires Dec 20,2018 * * MYCOMMISSION#FF 951469
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x• a: Commission #F N EXPIRES:April 12,2020
Bonded through National Notary Assn. TFOFF%o6 BondedfncuBudget NotMSerAces
Revised 07/1 2 1 -
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