HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED `
Date: Permit Number: I�O9S— ()40q
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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
-PROPOSED IMPROVEMENT LOCATION:
Address:
Legal Description:
Property Tax ID#: ���— `�\ �� l_1� — Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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DETAILED: DESCA"I.PTION OF WORK
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CONSTRUCTION INFORMATION
Additionalwork to be nertormed under this permit—check all appy:
HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: �1 S Ft. of First Floor:
Cost of Construction: $ 1000 Utilities:Sewer Septic Building Height:
01NNER LESSEE CONTRACTOR; , ,F
Name C. Name:
Address: 1 � C. ,eV -p— ( Company: P
City: State: . Address: i
Zip Code: 3499L - Fax: City: e yu State:
Phone No.��2— Z [CA z Zip Code: �sZ Fax: —� — �C
E-Mail: Phone No. _ i—
Fill in fee simple Title Holder on next page (if different E-Mail: e � ab I-czw-�
from the Owner listed above) State or County License: FCA Soo I(4C-(3
If 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:
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
commencing work or recording our Notice of Commencement.
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_Signatur o caner/Lessee/Agent Signat of Contractor/License Holder
STATE OF FLORIDA - STATE OF FLORIDALl
COUNTY OF � SL Sl CLQ COUNTY OF ��` Q 9Cs�Q
The forgoing Instri.4ruent was acknowledged before me The forgging instrument was acknowledged before me
thiday ofH 20((.0 by this day of 20 ,o by
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(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. �' a�������S�al) 9R_ _ _ 111111101111111 ENDA MARTIN sion N3 I ..`�► "�'t��''•, Seal}RENDA MARTINEZ
,•`i�"•,., �+ (Notary Public-State of Florid
A4 `�; Notary Public-State 0,Florida
Commission N FF 231565
Commission di FF 2'1 SOmy eomin.Exp res May 31,20 1
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My Comm.Expires May 31,2019 Bonded through f�tlonal Notary Ass
Revised 07/15/2014 °'' ` ''' Bonded through National Notary Assn.
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