HomeMy WebLinkAboutpermit application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 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 /'Z Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: I 0('� Cjy Occ-'4,J ePSS T 'CSN 40
Legal Description: /�j C2GS 7- 14c,&f
Property Tax ID#: 1_5 11 57` oyH o n Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Pau SAS, 0110/0 cG Syss� N� � 701J is,v S�ISSv�
IN C.C. 5,4Me
CONSTRUCTION INFORMATION:
AdWitfloo work to be pertormedunder this permit—check all appy:
HVAC L_I Gas Tank ❑Gas Piping _Shutters a Windows/Doors
Electric ❑Plumbing Sprinklers Generator F] Roof Roof pitch
Total Sq. Ft of Construction: Sq.Ft.
of First Floor:
Cost of Construction:$ LjL(�Sy Utilities:0Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name etAl/ AMeL4 1'-14,q IS62 Name: }�101AIm R-;
Address:_ ?v /Sf-f Company: tnv L_-Q 1 &MOLL V 1NC
City: f/AQA&AJI t1State: EL Address: G 33 N.� H,)R IZ;ti fN
Zip Code: i-L _� 1�� Fax: City: j�'S' L Stater
Phone No. ci S11 et& Xv3 Zip Code: 9qcl6 Fax:
E-Mail: / Phone No. 1)z 0 119 -12C21SLI
Fill in fee simple Title Holder on next page(if different E-Mail: 'Z L!p L.IC-A97(J 00 MCJS'7 MF
from the Owner listed above) State or County License:0/1 P_b 4 8 1 2.
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
i
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: .
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
commencing wor r recording our Notice of Commence
1C A
Signat e O ne L /Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 1:ik A,11c� COUNTY OF S Al�
The forgoing instrurpent was acknowledged before me The forgoing instrument was acknowledged before me
this 'Y day of , 20 .]k,-by this '1 day of110y ,20 16 by
(Name of person acknowledging) (Name of person acknowledging)
Signature of Notary Public- tate of Florida) (Signature of Notary Public-St;; of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identifi t'on roduced
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