HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1 S
Date: �� \ Permit Number: \Cod'
�• a RECEIVNOu
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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 lined
PROPOSED IMPROVEMENT LO,CATI `N, n r
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Address: 1
Legal Description:- ��C�.,I.QL�/1
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Property Tax ID#: �'Cy�" ly()�' L�o�`� �P Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
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CONSTRUCTION INFORMATION
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Additional work to e e orme under this permit-c ec a appy:
HVAC Ei Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
11 Electric ❑ Plumbing [:]Sprinklers E]Generator Roof
Total Sq.Ft of Construction: S . Ft.of First Floor:
Cost of Construction.$ 3,�da Utilities:cnSewer E]Septic Building Height:
OVUNE /LESSEE CONTRACTOR
Name Name: pec io_V e v►H
Address- Company: .0'
City: ( +�//11 State:_ Address: `�33 �/ 1 Or-
'Zip Code: 54,Qfft(4pJ Fax: / r City: C4. 5 Lu�l e. State:
Phone No. T�a I�t QLPQ(4 Zip Code: x1953 Fax:
E-Mail��k�✓ 14lflntvatle �O�, Phone No.-_ 7'] �Z-;Z0 -3q?b
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: L62t 1$15 032
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN`LAW.INFQRMATION` ` '
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 thepermit 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
lEomjnencing work or recording our Notice of Commencement.
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_Signature of Owner/Lessee/Agent S g ature o ontr or License Holder
STATE OF FLORIDA y 1 STATE OF FLORIDA
COUNTY OF �� t.���c-� COUNTY OF �T- L--0C o ',
The forgoing instruwas acknowledged before me The forgoing instrument was acknowledged before me
ent
this day of 20 _by this day of 20 by
(Name of person acknowledging) (Name of person acknowledging)
AA,d, 444uw'
(Signature of Notary Public-State of Florida) (Signature of Notary blic-State of Florida)
Personally Known OR Produced Identification Personally Known OR Pros¢—uced,lderBtificatiorrf!!'"`_
Type of Identification Produced Type of Identification Produced'"` ;��NA aIVENS
Public-5 a rrotTT°r"16—
C/ Notary es Dec 16,
Commission No. EE� ifS (Sea % t&WWWon No. 'c My Com � l�
e NOTARY UBLIC Commission#EE 858761
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STATE FLORIDA Bonded Through National Notary Assn.`
C.omm#EEW4748 �.
Revised 07/15/2014 F-xoines 311712,'Dl;r
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