HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INF MU BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Da z4i T,7Permit Number:
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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
PROPaSEO INIPROUEMENT LOeATICJN M
Address:
.J�gO 1�I0ss G—r I rA <� eYce. P L- 3� q�Z
Legal Description:
Property Tax ID#: �J�L 5 01-002-5 ®00 -,5 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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CC#N"TRUCT(ON INFC}RMATION
Additional work toe e orme under this permit-check a appy:
HVAC Ei Gas Tank ❑Gas Piping _Shutters +Windows/Doors
Electric 0 Plumbing Sprinklers F]Generator Roof
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction:$ Z^Z�Q~ Utilities:In Sewer 0 Septic Building Height:
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OWNERJCE55F CONTRACTOR sh,
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Name ny1ylaSujoY 5,0 V1 Name: Sew �i
Address: G 490 �-I SSS G I Company: () (i ()
City: A Q.1 C.Q_ State: L Address: Al S UJ q"� ` �QCC
Zip Code: 3 Z F`ax�:v, City: "!2N-al k6) Stater
Phone No.19(0<) Jr v f Zip Code: 3,603 7- Fax:
E-Mail: Phone No. 3(0.S 3C)OZ 3'�:v
Fill in fee simple Title Holder on next page(if different E-Mail: a�C�
from the Owner listed above) State or C tLi ense: C G C (5105-3Z Q-01 V
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIZNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: . 0':wS A 1141-UM 7 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
comme . work r cordin our Notice of Commencement.
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_Sign re of Own Lessee/A nt Signatu f Contract r icense der
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF PALM �1'C HL COUNTY OF PA L-M ��� I�
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 5 day of A 19P-1 L 20 /b by this 5- day of APe-►L 20 /';p by
1 .ESUS JIMr✓1JEZ JC—_;0S JIME-0ez
(Name of person acknowledging) (Name of person acknowledging)
Ignature of Notary Public-State of.J.1b
rida) (Sig ature of Notary Public-State of FI I a)
Personally Knowny OR Produced Identification Personally Known I/ OR Produced Identification
Type of Identifica ' Type of Iden t' ' „ „
=o:. �� SAND :•o: c•
SANDRA P D
Commission NO. MY cOMMI, #FF070599 'n`
�� COmmiSsion FY MY COMMISSION1599
iqr..oe' EXPIRES January 13,2018
''•,FOFn '••.,,FaFpo,; EXPIRES J2rluary 13.2018
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Revised 07/15/2014
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DATE
COMPLETE
INITIALS