HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFOU$ BBE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I /unC� Permit Number'.
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 J�--
PERMIT APPLICATION FOR: To Select from dropbox, click here
PROPOSED INPROVEMENT LOCATION:
Address:
Legal Description: —11 `(A t (tel lel-tie
Property Tax ID 0CI(��l)Ci,
Site Plan Name:
Project Name: F lOeen �N-a(`I-QQ
Lot No.
Block No.
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
I A- Pr Pel Pr YPf7
tCP(V1P V 1
CONSTRUCTION INFORMATION:
niona wor to onerformed under trio permit —check all appy:
❑HVAC Gas Tank []Gas Piping _Shutters
❑Electric F2=2blumbing ❑Sprinklers ❑Generator
Total Sq. Ft of Construction: SgI__Ft_.I of First Floor:
Cost of Construction: $ %_�.l.Y 4 Utilities: hl Sewer ❑Septic
❑Windows/Doors
❑Roof
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name q
Name: UXI i
Address:
Company:
City: 2 e_ State: ]!�J
Zip Code: S4C`14-� Fax:
Phone Na. �%Z �'),�.- �)
E -Mail:
Address: L
City: yciirto
Zip Cod�Fax:
Phone No.
0 n St te:�l
1F -K3 Zl3'6_lZ
� "
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: i��"
State or County License:
1c0i
CSI �I�S�i l "Z1 7
Ifvalue of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
Name:
--""""""" MORTGAGE COMPANY:
Appliuble
Address:
Name:
_Not
City:
Address:
Zip: Phone:
State:_ City:
State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Not Applicabl e BONDING COMPANY:
Applicable
Address:
Name:
_Not
City;
Address:
Zip:Phone:
City:
Zip:Phone:
DWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated
I certify that no work or installation has commenced prior to the issuance of a permit.
non at t e granting of this requested permit, I do hereby agree that I will, i
e with t e approved plans, the Florida Building Codes and St. Lucie County
i buildi g permit applications are exempt from undergoing a full concurrer
uctures swimming pools, fences, walls, signs, screen rooms and accessory
TO O NER: Your failure to Record a Notice of Commencement n
mts to our property. Notice of Commencement must be reg
first ,r ection. If yo I nd to obtain financing, consult with
I)i wnr4 nr .e�...a:__.. .._ .,r. _
STATE OF
COUNTY(
The fo aing Instrument waas acknowledQQe��before me
this �ay of _[�'r -72 by
Personally Known (i• OR Produced Identification
Type of Identification Produced
Commission No.
Revfsed07/1$/2014'"!Rn°F EXPIRES May 7. 201e
holder to build the subject structure
rants that may restrict or prohibit such
restrictions which may apply.
'pspects, perform the work
ddments.
mew: room additions,
to another non-residential use
esult in your paying twice for
ed and pd,5ted on the jobsite
er or an a ornev hcf—
STATE OF FLORID l /��
COUNTY OF
The fojgyug instrument as acknowled66eddb�before me
this/// day of p�20MW by
—LUlY l lt� ( /
(Na rf ie of person acknowledging )
Lurfhla ry Pu lic- State of FI rida )
Personally Known _�R Produced Identification
Type of Identification Produced
Commission No.j '. '.eZ' agb cv...._...�_..
MY COMMISSION #FFt20712
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