HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /2 5 /�2_o I Permit Number: �W 03. N30
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
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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 LOCATION'
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Address: 3-1� ) Road
Legal Description: E Pup ill S I LASS LOT 2�4_
(DR �;Snn- 1 I C)1)
Property Tax ID#: -13331- 6C0-- 003o-- onn- ( I Lot No. _
Site Plan Name: 1^ ; Block No.
Project Name: � 0C o(ne a I�
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF'WORK: €'
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PQTcve old AC Unit 2. kons cxnd 'ins+dl new! a►ir
C-Oifi►cn►nc� sm 2 �nS 16 StER.
CONSTRUCTION INFORMATION:'
Additional work to be
l rtormed under this permit—check a f
appy:
HVAC LJ Gas Tank ❑Gas Piping _Shutters a Windows/Doors
11 Electric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction:$ Z- 1y� Utilities: _Sewer E Septic Building Height:
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OWNER/LESSEE;:
CONTRACTOR"
Name S Name:
Address: 439- n Company: '!N r core
City: Y� stater Address: I q 34 SW � ,1tnjore �lreet-
Zip Code: �1 Fax: City: l Int u.J ae Stater
Phone No.'14 L..448 4-G13 Zip Code: r- 4q -1-. Fax:
E-Mail: Phone No. L—
Fill in fee simple Title Holder on next page(if different E-Mail: 11'k OfGl�t''nye na++ of
from the Owner listed above) State or County License: I 6 VE)
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUP,PLEMENTALCONSTRUCTION LIEN LAW.INFORMATION
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY Not Applicable
Name: Name:
Address: Address:
City: State: City: I State:
Zip: Phone: Zip: Phone:.
FEE SIMPLE TITLE HOLDER: ANot Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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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 covenantsthat 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 respelcts,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 a i other 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 le der or an at orney before
commencing work or recording your Notice of Commencement.
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_Signature of Owner/ gent Signature of Contr r Licen ie Horder
STATE OF FLORIDA,. STATE OF rffRIDA
COUNTY OF1-�,,��, COUNTY OF ;,�
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The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20by this day of 'MOn 1.� .20 )(s by
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(Name of person acknowledging) (Name of person acknowledging)
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s�
ig�ture Notary Public-State of Florida ) (Signature of Notary Public- I ate of Florida)
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Personally Known OR Produced Identification Personally Known OR Produced Identification
T e o Id'entiific_ation Produced Type of Identification Produced
j_'1�W -,Aq O A-)(41-13 -
Commission No. (Seal) Commission No. (Seal)
ASHAHNA INGRAM Y't ;HNA INGRAM
:P"y`'yap Public-state
Notary ,���� is-
Revised 07/15/201 =:4;` "; Exp+res Dec 20,2018 =_� Expires Dec 20,20 L
�, �y;,„•, �� FF 177249 {` nission#FF 177249
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REVIEWS FRONT-7-°--""=ZONING SUPERVISOR PLANS VEGETATION ` -EATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW !i REVIEW REVIEW
DATE
COMPLETE
INITIALS
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