HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED l /
Date: 5 t� Permit Number.
• -_ RECL75
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
PROPOSED IMPROVEMENT LOCATION: =� 6:
Address: (� COLI hh_ 'I r (e C Z `'►
Legal Descri ti '�_ v� L. s a- S ' (tel Ll I -
�of ,r
Coqae 3�(�c sl (f � D�3?- logs
Property Tax ID#: `10 2 h f O- 0055 000 -(9 Lot No.13 3
Site Plan Name: �,` / Block No.
Project Name: 0 -es!} �QI UW� I
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION IF WORK:
CONSTRUCTION INFORMATION:
Additional workto e e orme under t -checkispermit a appy:
OHVAC L_I Gas Tank []Gas Piping _Shutters I1 Windows/Doors
Electric 0 Plumbing Sprinklers M Generator Roof
Total Sq.Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ I (P 00. Utilities: Sewer 1:1 Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name Wo L10Name: I e
Address: Company: bo SY S-
City: State Address: I ((J S- V
Zip Code:�.,L��1q p Z Fax: /01 City: �(,C, State:' G �
Phone No.�/ C- O 2^d l�f Zip Code: ����Qr1 Fax/:
E-Mail:)1A Phone No. 0
Fill in fee simple Title Holder on next page(if different E-Mail: l ilJ�U �.Q M
from the Owner listed above) State or 6oInty Li a se: — Z 0
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATI.M. .
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:Yo r failure to Record a Notice of Commencement may result in your paying twice for
improvements to yo/r/4erty. tice of Commencement must be recorded and posted on the jobsite
before the first insy end to obtain financing,consult with lender or an attorney before
commencin wor • our Notice of Commencement. '
'A01�/ _
S
_Signature of Owner[Lessee/Agent Signaturi of Contractor/License Holder
STATE OF FLORIDA}--e �� STATE OF FLORIDA rev-��
COUNTY OF ` `I a COUNTY OF
The f r__��p.�in.g instrurnent was acknowledged Pefore me The forgoing instrument was acknowledged before me
this 1U day of 20 t0by this day of 0,1A .20 ��by
1eA A_e_�LL
( ame o erson acknowledge g) (Name o person acknowledging)
(LSiKatur 2f
Notary Public-Sta of Florida) (Slhurlof
NotaryubijC-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Pr, ype o Identification Produced
`oto.,...... JEANETTE DANIELLE OGEL
'_' °' i sionNo. °�'"YP "° JEAN PANIELLEVOG
Commission No. _ NW&MMISSION#FF RAW =° '`,
'.�'' oe= •€ MY COMMISSION#FF1149
EXPIRES April 21, 2018
(407)398-0153 FloridallotaryService.com "•••.,oFflo,.�
Revised 07/15/201 (407)39"153 FloridallotaryService.com
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