HomeMy WebLinkAboutBuilding Permit Application ' ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ff!
Date: Permit Number: 1(00^ . _)aA23
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 __X_ Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPrROVEM.ENT,.LOCATION: '
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I
Address:
Legal Description:
Property Tax ID#: Z l ,2-b I - CVS- c(-_0_q Lot No. "I
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED--DESCRIPTION OF WORKbrb Y-v-\ hz�Lt (a�d
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P
COfV.STRUCTION INFORMATION ' `� &
Additional workto. e er orme�� under this permit-check a appy:
HVAC Gas Tank []Gas Piping _Shutters ❑Windows/Doors
LMElectric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction: $ (�;� Utilities: Sewer Septic Building Height:
OWNER/LESSEE CONTRACTOR
Name SblS2 Name:
Addr, � S I Company:
City: State: Address: (N(—) W0_,
Zip Code:-71)"�_)p n9 Fax: City: State-In
/
Phone No.- Zip Code: Fax:
E-Mail: Phone No.—E2 , 4�0 -
Fill in fee simple Title Holder on next page(if different E-Mail: L 0_6 . Cz"�'_
from the Owner listed above) State or County License:FC,1:�00LQq'�)
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
FUPPLEMENTAL CONSTRUCTION LIEN .LAW.IN.FQRMATION,: i; � €f
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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.
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_Signatu o caner/Lessee/Agent Signat f Contrac o Licen a of r
STATE OF FLORIDA i STATE OF FLORIDA I l
COUNTY OF COUNTY OF �_ t ��C�_L
The forgoing instr�_rnent was acknowledged before me The;orgoing instr.rn nt was acknowledged before me
this ay of L 20 Eby this day of lG V�t 20 by
Ct_ Z)1�1 o'_
(Name of person acknowledging) (Name of person acknowledging)
( ignature of Notary Public-State of Florida ) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No �CJ�Ci� n No. � ) S
•�.av;V a,,, BRENDA•MAR NEZ �.4�`'av"n"�e,� BRENDA MARTINEZ
Notary Public•StAtO of Florida Notary Public•State of F i
•;_. Commission 0 FF 231585 Commission*FF 2315
Revised 07/15/2014 =� My Comm.Expires May 31,2019 ;� My Comm.Expires May 31, o
°�f��`: Bonded through National Notary Assn. '",°�its
� Banded through National t�;,
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