HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 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 esidential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION: $ ` '
Address: i2. q q�
Legal Description:
Property Tax ID#: c-) oou c� lad Lot No.
Site Plan Name: . Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
a� I
DETAILED DESCRIPTION OF WORK:
�t gAme, Fox Mt -J-0/J A/� 64-7-
U)A Two 16 & C, P, C'i fo /&J 1164
CONSTRUCTION INFORMATION: `
-AAdiffig6al work to be ertormed under this permit-check all appy:
HVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
FlElectric ❑ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $. 'c30 Utilities: _Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR':
Name k Name: T( ,f4AP /CflP_-s-,
Address: oq 'D 1/iNE Company: (10f-A C' 4Ir- W
City: Favr Ptt'XC . e(' Stater, Address: �aPitaur .c'j
Zip Code: J q!G,!Z... Fax: / City: State:-LL-
Phone No. -Q14 AC) i 9443 Fi Zip Code: 49 S Fax:
E-Mail: Phone No._ �1;_ �`��°1 .2j'1 J ILJ
Fill in fee simple Title Holder on next page(if different E-Mail: VuoU R-)r a CcS.I'')CA.� -r
from the Owner listed above) State or County License: i LAW q 5� IJ-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: 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
com_wteQcing work or recording our Notice of Comm e m t.
s
_Sig of r/Less /AgentC Sbature Contractor/Li nse Holder
STATE OF FLORIDA STATE OF FLORID ,
COUNTY OF ��A o. COUNTY OF l_ .i,Cxs�
The forgoing instrument was acknowledged before me The for oing instrument was acknowledged before me
this 4 day of 20 (�by this day of 20 [b_by
(Name of person acknowledging) (Name of person acknowledging)
gnature of Notary Public-Sta of Florida) Signature of Notary Public- tate of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
T peI�etification Produced -Type of Identification Produced
1 Vim - 44-!! t 42,2.0
Commission No. y �
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Lp$HAHNA INGRAM c�tiP s
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Revised 07/15/2014 ,` Commission#FF 177249 '�•;;F FF4oar
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