HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECEIVED SEP Z 3 DIS
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 r
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: .5017 91I?Gy, Dowe,
,- �( f _
Legal Description: �iYIUICa� Qveg EALA S
Property Tax ID#: 37o-?_aos-01716--(7oe—.3 Lot No. 1/0,14-5,
Site Plan Name: Block No. '7 7
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRLPTION OF WORK:`
'�, 115 ova c�( v\.e,_-, vx� I'Y,e .(eovw, 4h2, wc4e-2 w"-P," 404hk kOLtsP)
140 \N Vci 1 V-e ti•,os e b' b C>mc Vczc"u w, bpm
CONSTRUCTION_ 'INFORMATION:
Additionalworkto a r orme under this permit-check a appy:
HVAC M Gas Tank []Gas Piping _Shutters Windows/Doors
OElectric 10—Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: Sewer O Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name ss1 CC Name: L' S 1�.0�
Address: 7 N�I� "F J' �� Company: I C
City: '�i l e � State: Address: GO PW DEADPM Ave
Zip Code: Fax: City: PS t State:
Phone No. /.3!7- 5kg7 Zip Code: Fax:
E-Mail: Phone No. -673'
Fill in fee simple Title Holder on next page(if different E-Mail: WI (VNC �C).C0 VN
from the Owner listed above) State or County License: C4EW 11,29 03q
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: Ad d ress:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLEHOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Ad d ress: 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
commencing work or recording your Notice of Commencement.
2 &2�� S
_Signature of O ner/Lessee/Agent Signature of Contra ctor/L cense Holder
STATE OF FLORIDA J / r STATE OF FLORIDA ('1 L�U
COUNTY OF Jam/ L�ICi COUNTY OF ✓ e
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledge before me
this day of 20 aby this Aay of !C/M b&f 20 /6 by
t� �vq J4 o� _ yI5IL21 k1 0A/
(Name of pers acknowledging V (Name of r Pn acknowledging)
(Signature of Notaryic-State of Florida) ATIgnature of Notary u c-State of Florida)
/Personally Known�OR Produced identification / Personally Known _OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Comrn i _ Seal)
JOHWATHAN RAYMOND FITZPATRICK
Pr' JOHNATMN RAVOONO FIYZPATR49
COMMISSION#FF233682
Revise .o-, 014EXPIRES May 21,2019 EXPIRES May 21,2019
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