HomeMy WebLinkAboutBuilding Permit Application ALL APPLICAB • INFO 4UST
/BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 20 Permit Number:_ I l_(l
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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: CCTo Select from dropbox, click arrow at the end of line
PROPOSED I'MPRPOW N, LOCATIONS"f
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Address: 21Y Ch ,4 ►7~,/OY'!S Gt," Q>'i��ik✓I Z�dGi y98�
Legal Description: //
Property Tax ID#: �5 3-5 Lf - SO I - OO 8 ` O O C> Lot No.
Site Plan Name: Mi L h`e on vvS Block No.
Project Name: K C4 yx C
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION.OF Wi:ORSK . . `'
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CONSTRUCTION fNJ=PR `rATION� r'v
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Additional workto •e a orme under this permit-cl ec a a w x
HVAC Gas Tank Gas Piping _Shutters Windows Doors
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Electric Plumbing Sprinklers 1:1 Generator M Roof Roof pitch
Total Sq. Ft of Construction: // S . Ft.of First Floor:
Cost of Construction: $ �J (O�• �� Utilities.Sewer Septic ; Building Height:
OWNER LESSEE .,
FF CaNTRa
Name Name: vS
Address: 2- 47 G'do;A Company: t%� o�✓S Ib
City: St te: Address: lip S
Zip Code: O`T'0(0 Fax: City: 1-1,) State:(i
Phone No. �9 0 q3 S -O y &S Zip Code: 3 314,G 0 Fax:
E-Mail: Phone No. S6/ S j'S 3Z
Fill in fee simple Title Holder on next page(if different E-Mail: ci/7 .e l� hCI-7�Cr r
from the Owner listed above) State or County License: �5_13cs
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SU:PPLE.MfNTAL CONS,I IUC�T1O,N LII�NO'LA1N INf�f �;/IA�iI�ri' �,; - fit w?31N?-, � �
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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 aiad 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 ur Notice of Commencement.
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Signature of Owner/Lessee/Coniraffor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLO _ ,,j_ STATE OF FLO=i►
COUNTY OF �� i LUG Q COUNTY OF T ---, ls,�_
The forgoing inst 1 ent w s acknowledge before me The forgoing instr ent as acknowledged before me
this_Wday of 20 Jby this2Q day of 20 &by
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(N a of person ackno dging (Name person acknowled )
(Signature of Notary Public-State of Florida) (Signature of Notary Public-S, of Florida
if cation )
Personally Known OR Produced Iden ° Personally Known)C/ OR Produced Iden
Type of Identific d. Type of Identification Produced
"""""•. RASHELLE SCHMIDT RASHELLE( HM
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Commission No. =:. �: Notary Publi�S��e of Florida Commission No ,.•��'" "e:%- Matey public- Florida
• My Comm.Expires Mar 24,2018 -•: ;• My Comm:Expires Mar 24,2018
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Through Notary Assn. '•�„�����••• Bonded Through National Notary Assn.
Revised 07/1
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