HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: !L f-:)hCO 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 V_
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
1L
Address:
Legal Description: \�1 �C�( CJ�CS�0.2u ll,�� ►"fit a�•
Property Tax ID #: %` D� CC)j)_U Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Lo See
O iSTR 'CTION INFORMATION:
Additional wor to be ertormed under this permit - check all appy:
HVAC Gas Tank ❑Gas Piping Shutters Windows/Doors
11 Electric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $� ^t �3D Utilities: _ Sewer O Septic Building Height:
Name ( 1 � ► V, W
Name: ` P�
Address: IQa 4AI ►'.
Company: Cjl�r`� e - V)
I
City: . V i eArc-e. State: Q .
Address: eZInt-
City: EL. R PJ✓tR___ State:
Zip Code: :�)L,C LALo Fax:
Phone No. ?7-;� — 14io 5 - Z4 Lo-3&
Zip Code: 'SgC1d 3L_ Fax:
E-Mail: N 1A
Phone No. _77-5597— 3377
Fill in fee simple Title Holder on next page ( if different
E-Mail: C66) i CXZ •C6YI-1
from the Owner listed above)
State or County l_ ense:r 1 &'5
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: _
Address:
City:
Zip:
Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: _
State
of Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
of Applicable
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 wcak or recording your Notice of Commencement.
/ Lessee/int
STATE OF FLORIDA
COUNTY OF �'J. L�,_u r, -
The forgoing instrument was acknowledged before me
this day of 20 J&by
(Name of person acknowledging)
(Sign atgAefNiRVA ftubtVf Florida
wn OR )
��\\\ 11111111 I I I llll/
Personally KnoProduced`i��81�
Type of Identification Producedo&�v1arY 2,?..W
1.V
Commission No. FFi95337=
2 : #FF MW
Revised 07/15/2014
rise Holder
SIVE Of FLORIDA `
COUNTY OF V� t
The forgoing instrument was acknowledged before me
this day of '-_'bl"u0-trZ 20 Itp by
r_�
(Name of person acknowledging )
W_�-
(Sig—natuof Notary Public- State of Florida )
SABRINAJ.,BLACK
Personally Known OR Produced Identtif' n
Type of Identification Produced ��\\\1j1��i ��////
FF9
15337 "
Commission No. ` ay2
#FF 195337 ; Q
i�� ••:Y sonded�N 'l� Q
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