HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I J - 3 f -16 Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 !Virginia Avenue, Fort Pierce FL 34982 , f
Commercial Residential
Phone: (772) 462-1553 Fax: (772) 462-1578 V
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of tine
PROPOSED IMPROVEMENT LOCATON: t
Address: O O I -ane
Legal Description: t fx, r c 4 r n C_ 1 e
Property Tax ID #: _9q ;q - 9 o 6 - - Lot No.
Site Plan blame Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED [DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work to b rtormed under this ermit -check all that
apply:
windows/Doors
0HVAC Gas Tank as Piping
�
Roof pitch
- aElectric Plumbing Sprinklers
Generator
Roof
Total Sq. Ft of Construction:
w?
So.
Ft. of First Floor:
OSeptic
Height:
Cost of Construction: -1 C U Utilities:oSe-viver
Building
OWNER/LESSEE:
CONTRACTOR:
t
Name Qr)nc,�r� �rc�-
Name: _\t�trl Wr21�Jr✓
Address: `� -( !cit f �t1 •
Company: �-,4LVM
n �
'1.
City; + fi _ ��i ere State:
Address: d
i r CSS
Zip Code: t Fax: rtr 1A
city: 4 - .
State: f =
Phone No. d % `� -
Zip Code: -i`t
Fax: ",//A,
E -Mail:
Phone No. '77
Fill in fee simple Title Holder on next page ( if different
E -Mail: a Gti✓+ ft
C
from the Owner listed above)
State or County License:
, 2(a -7
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
f
Not Applicable
� PP MORTGAGE COMPANY:
Name:
Name:
Address:
Address:
City.
State, City.
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
_ Not Applicable BONDING COMPANY:
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone.
Zip: Prone:
1 certify that no work or installation has commenced prior to the issuance of a permit
Not Applicable
i
State:
Not Applicable
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 pians, 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 r cording your Notice of Commencement. j
Sig Ow
Contractor as Agent for Owner at Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF Si : �.a tr.' COUNTY OF 'S'A L`- Cr
The forgoing instrument was acknowledged before me
this I Vday of fivhe 20 Eby
) I4 q I ,,-i 11. e tit,
(Name of person acknowledging)
,fg"ature of Notary Public- State of Florida)
Personally Known I/' OR Produced Identification
Type of Identification Produced
The forgoing instrument was acknowledged before me
this �Z I f"day of tqC .20/ by
(Name of person acknowledging)
(S" ature of Notary Public- State of Florida )
Personally Known t'� OR Produced Identification
Type of Identification Produced
Commission No. >r r`> q rc CIC;I+� _ Commission NO,
ea`tlJtr
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MW M A UIERSgwI.1i !� k • Stff# Of Florida
Revised 07/15/2014 Ct SW * FF 965546My COMM. Explres Feb 28, 2020
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DATE
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