HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: -�' I I` 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
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PERMIT APPLICATION FOR: To Select from dropbox, click arrow;at the •end of line
PROPOSED IMPROVEMENT.LOCATION:
Address: Iwo UO b RL 10N "Kb
Legal Description:
Property Tax ID#: 412A 03 1 Cool Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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DETAILED DESCRIPTION OF WORK:
CDP- 6 3 'jo v 0/6- S'(lsS f;r7 1 °O -S
tNt_L /t2p J /46,47- -St1rk 11s �x�s
CONSTRUCTION INFORMATION:.
A iti a workto e e orme under tispermit-c ec a 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:$ .3`boo Utilities: _Sewer 0 Septic Building Height:
OWNER/LESSEE: CONTRACTOR: ;l,
Name Wnt-'cpz )C-HAkF_S14.1 Name: 2101.AM L74AA?_r
Address: (�t�(j RCSp,J� Company:�.111�4)H A/4 (w
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City: ,�� Z � Stater i Address: X33 N11 cZOa (�
Zip Code: Y-9 �1 � Fax: City: ag:r Ss Stater
Phone No. 0AV1_-h.5 &Su-Sete) 609 91 o16 r)1-4 Zip Code: 9'gelb3'1 Fax:
E-Mail: Phone No. <log zl 9> 4qsLl
Fill in fee simple Title Holder on next page(if different E-Mail: Vt,L �'- Com C S`S fo' 111crT
from the Owner listed above) State or County License: CAeU t4&0,5-
If
4&0,5If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: '��.
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY= _Not Applicable
Name: Name:
Address: Address: 1.
City: State: City: 1 State:
Zip: Phone: Zip: Phone:
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FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address: d
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 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 lendell an attorney before
commencing work or recording our Notice of Commencement.
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_Signature of Owner Lessee/Agent Signature o Contractor Licerise Holder
STATE OF FLORIDA STATE OF FLOR
COUNTY OF •�vx_ COUNTY OF M
The forgoing i trumentwas acknowledged before me The forgoing i trument was acknowledged fore me
this day kf 20 �by this Z' day 20 y
( ame of person acknowledging) (Name o person acknowledging)
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fSignature of Notary Public-Stat f Florida ) Si at re of Notary Public-St41S of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification roduced Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
a."""'�% LASHAHNAINGRAM
s° ,`�•; Notary Public-State of Florida ,,,����,,, LASHAHNA
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Re 5,)�Mf4mm.Expires Dec 20,2018 'o�P e��•; Notary Public-State of Florida
;� Commission#FF 177249 .2; *;•?My Comm:Expires Dec 20,2018
� one rougn N;tional Notary Assn..
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