HomeMy WebLinkAboutBuilding Permit Application 'i
ALL APPLICABLE NFO /UST COMPLETED FOR APPLICATION TO BE ACCEPTED Q /
Date: - ( �(0 h Permit Number:
2
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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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line C13
PROPOSED IMPROVEMENT LOCATION:
Address:2.1O4 V 64 T r �L 11914U
Legal Description: �CA- 4-3 p• 131 v CIL LDS
Property Tax ID#: - r b 0 S_( - Lot No.
Site Plan Name: Block No. Y
Project Name: E:2I (2�
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
�lcpgi r c01 rt-, i r\ �c CA '(Z�plgec C '�- P�acle ►ni5►de and &.4 ill a OF -�I1e hour
Chun3e aQQ IJON prof t��pna►I e c}neaQ Zn�1o►Iloctoi on I Cplgce 'Q.e ee p}i el c pee}1 e}
�n SpuN'M uoo- %r\ �7-t par r Some breaV-*rs Is n ttl ecWl0a9 pUnal 4hQ} hA 0't r u.S}.
CONSTRUCTION.INFORMATION:
Additional work to be nerformed under this permit-check all appy: s
HVAC 13 Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers F Generator E]Roof Roof pitch
Total Sq.Ft of Construction: S .Ft.of First Floor:
Cost of Construction:$ ® Utilitles:n Sewer 19 Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name L .v-<, PLO ( �, Name:
Address: O /_Ld I- Company:EoS� (fi=t\ F_lec=- cl �l .
City: he/-G L State:JEL Address:!iSM k�iUQ Me_ 4 AC)z
Zip Code:_ 3 q cl L/& Fax: City: c1n State-
Phone No. :E�3 r - �_ 24' Zip Code: owl Fax:
E-Mail:} Phone No.! 1Lp k- Qs1- Lo u O o
Fill in fee simple Title Holder on next page(if different E-Mail: GIS-k 0C..I'I,nVAP_CkA CSC-XrrCt►1.f(St•1
from the Owner listed above) State or County License: 1
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _c,-tlot Applicable . MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ of Applicable BONDING COMPANY: _Lflot 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 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 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 our Notice of Commencement.
114LetJ IS otmi G�►.Ut.!] Q4V-41 s
Signature of Owner/Lessee/Contract r as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA �
COUNTY OF �� /� �6��4 COUNTY OF 4'<!'�// �G'c�✓!
The fo oing instru e t was acowledged before me The fo omg instrument was acknowledged before me
this day of O a2�!� 201Z-by this k day of x/6/0- 20 _!�6 by
lelt_ � /Oko"' - ��
(Name of person wledging) j (Name of person acknowledge
(Signa ota Public-State of Florida) (Signature of to �u i tate of Florida)
Personally Known OR Produced Identification Persona ly Known � OR Produced Identification
Type of Identificatiofi Produced Type of Identification Produced
Co IOLI a Commis`sigoft., MARIA C.VIOLI (Seal)
r'p"�. ;2�`w B�% Notary Public State of Florida
Notary Public-State of Florida
Commission�►FF 977527
commission My Comm.Expires Jul 19,2020
Re - ,
�m.Explres Jul 19,2020 %�°'f���.r� Bonded tfuout�Nstbrisl Notary Assn.
''��° Bonded rough National Notary Assn.
Y"° .
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