HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date
Permit Number:
'ry R T171' 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) 452-1578 Commercial Residential r
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address:
�� f_ i e-rce - 3 q F 8�
�� � � ,`Y�� ��� fir` c d v �f s
Fz
Legal Description:
Pro pertyTax ID#: �` � �'U6�`i'r( DJt Lot No.
Site Plan Name: l4"�C/,-"_� Block No.
Project Name:
0 t,r-
Setbacks Front Back: % Right Side: �� Left Side: `
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional wor to e e orme under this permit— check all that apply:
HVAC Gas Tank []Gas Piping Shutters Windows/Doors
OGenerator
Electric Plumbing Sprinklers ❑ 1 Roof
Total Sq. Ft of Construction:
Cost of Construction: $ Z506 —
SFt. of First Floor:
Utilities: l _lSewer 0Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name i 5 +1 e s S
q
Name:
Address:
Company: �elu5n �ewce �_,.;�r� ✓� �rc..
City: ==cyte State: i�
Zip Code: `�� Fax: _
Phone No.
Address: Z(66-5&)
City: i S L- State: R -
Zip Code: _3Ki�� Fax:
Phone No. 77Z - Mfg- Z 3a
E -Mail:
Fill in fee simple Title Holder on next page t if different
from the Owner listed above)
E -Mail: �e'J,'e . a i c� Tin a ,.c ass
State or County License:
It value OF construction is �zsuu or more, a KtCORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: i
Address:
City: State:
Zip: _ Phone:
City: ; f` State:
, Zip: Phone:
FEE SIMPLE TITLE HOLDER: � Not Applicable
Name:
BONDING COMPANY- _Not Applicable
Larne:
Address:
};=
Address:
City: �` ..
City.,i'
.....-.._
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 rues, bylaws or and covenants that may restrict or prohibit such
structure. Nease 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 rlorida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a ful! 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 thejobsite
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.
-. 7
Signature of Owner/ Lessee/Agent I Signature of Contractor/License Holder
STALE OF FLORID STATE OF FLC)RfCi
COUNTY OF - -.�: ,-- COUNTY OF �fi C_ `.
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before rine
this day of , 20 __by this day of 20 by
(flame of person acknowledging )
(Name of person acknowledging )
(Signature of Notary Public- State of Fiorida j (Signature of Notary Public State of Florida }
Personally Known _--OR Produced Identification Personally Keown OR Produced identification
Type of identification Produced Type of Identification Produced
Commission hl `{ f ` =7�"C ,�Rr !) n No. `rf �' q4 4a�V aI) KIRK ARI K
�+__ KlFiK ARI A FZ r'4Y CO�lMlssiori
ReN�sed 07/15/2014
€Xj'lMIES August 12, 2017
398-0153
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