HomeMy WebLinkAboutBuilding Permit ApplicationMLL Ar'I'[.iLHt5Lt 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 Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IM, P/ROVEMENT LOCATION:
Address: r -v -A � 4� lP
Legal Description: I %,
Property Tax ID #: - Lai No.►
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF'WOREC:
ni l E �-z �� 15
to z�s
CONSTRUCTION INFORMATION:
ACM monal work to e Per Orme un ert is permit - check all appy: LI
E] HVAC D Gas`fank E]Gas Piping In Shutters Windows/Doors
L__lEIectric 1 PlumbingSprinklers I Generator L=I Roof
Total Sq. Pt of Construction:
Cost of Construction: $ SSL a."
Sq. Ft. of First Floor: _
Utilities:Sewe r Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name: Y()SP,Dy) -ruE�4'.___...-_
i Address:c5 ►
Stater
Zip Code: aqQkzs Fax:
Phone No.
Company: Genet si�m�`a2ft!}c E.S -T o�c.
Address:. &Oa 5� �vl a;�,_ Ave -
City: FbS', I_i{ret(' State: FI_
Zip Code: 34T52
Phone No. 1-71-3;�-7- 3G _
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: C�ehesss ��iar�bEn Se�U�ces rn tern
State or County License: C G kLA 2 b
It value of construction is $2504 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER:
Name:
Address-
City-
Zip:
ddress:City-Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: _
Not Applicable
State
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name: _
Address:
City:,
Zip:
Phone:
Not Applicable
ate:
Not Applicable
I certify that no work or installation has commenced prior to the issuance of a permit_
St. Lucie Countyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in structure. Pleasecc consult with pyour Hkome Owners Assoc'iation and reAssociation view bylaws ur deed fdor any restrict on ts that which mayaprohibit such
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, walks, 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
commencini; work or recording your Notice of Commencement.
re of Owner/Less Tractor as Agent for Owner
STATE OF FLOitjDA,
COUNTY OF
The f r Ding rostrum nt was acknowledged before me
this day of 26 bby
(Name of person acknowledging ]
(Signa re of Notary Publi:OR
ate of Florida
Y]
Personall Known Produced identification
Type of Identification Produce
MARIAH MILLS
Commission No. (PT�fission#FF4237G3
Fxpites June 3, 2017
�e....,� BudedThNTmvFainlnsuarzcea00.38r7B19
Revised 07/15/201.4
re of Contractor
STATE OF FL DA
COUNTY OF -�
The forgoing instrument was acknowledged before me
this a day of N Q>41��_OkK , 20 L_�Q by
(Name of person a�nowledging ]
(Signat re of NotaryPublkc- ate of Florida
Y ]
Personall Known � UK Produced Identification
Type of Identification Produced
:w M �IAh 43U
(5J4�ia, irsysFzoni4
=F9tc3C Commission No. cXpi J ne 20
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REVIEWS
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DATE
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