HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
A
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, 5RECEW'D NOV 2 8 ?.016
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 L'
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 IMPROVEMENT LOCATION:
Address: 32(20 3h0rtk �3rCU =)r,v,L /
Legal Description: 1c,-r-,1--)on la y c�Uh C��✓r S� D� ( /�(� G9-,2
�6r 3�s13
PropertyTax ID#: / 3 " S(o(o - DUv2 / - UUO - L/ Lot No.
Site Plan Name: Ph�� 3/��•Y ,�9_.it1:L/ ��OYYZ Q S. Block No.
Project Name: /Q✓;/�Uri ��
Setbacks Front Back: Right Side: Left Side:
DETAILED-DESCRIPTION OF WORK:
l evv
CONSTRUCTION INFORMATION:
Additional❑_HVAC or to ewe Gas Tank rtormed under this permiGas Pipingt-checka _Shutters Windows
IL_ /Doors
11 Electric ❑ Plumbing Sprinklers I Generator 1:1 Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ �� O U Utilities:Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
�Y /-)0,-)12e Ccs Name:
Name _
Address-J/ (,t .__.C ae) 0_• [�C�• Company LjC ii/ /S //2e.
City: l�Yi c,/�lc�ri �zi� State:AILI Address: y,
Zip Code: //7/g Fax: City:_ bo 1 I State: FL
Phone No. Zip Code: Fax:'S� s9c)
E-Mail: Phone No.S� U��j
Fill in fee simple Title Holder on next page(if different E-Mail:/J,4-,� , ) e,3e✓L_n/-)(), /Ctc-,-f i/7C• D�
from the Owner listed above) State or County License: /L16-i9-/ %O�y
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW°INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name:JvnC'OG�S� !��(JYn�n�Y'� Name:
Addressi (;,-3b 1.1• 0.5c_ r0/ Address:
City:cl ", W State:_ City: State:
Zip:3376,D Phone:797- -3;--goo6 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 acc(N�y uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commence nt eaeIt in your paying twice for
improvements to your property. A Notic! of Commencement must ereand posted on the jobsite
before the first inspection. If you intend to obtain financing, consult itor an attorney before
commencing work or recording our Notice of Commencement.
s
S gnature of Owner/Lessee/Contractor as Agent for Owner Signatur t actor/License Holder
STATE OF FLORIDA& � S ATE OF FLORJD/4
COUNTY OF COUNTY OF ( ff ty0 /,I.
The forgoing instr' w s acknowledge efore me The for oing instrument was acknowledged before me
this d/ da of 0��by this day of /��1/lzY��p i ,20 by
l /e y(-L rc/
(Name of person acknowled in (Name of perso ackn wled
(Signature of Notary Public-St of Florida) (Sig a of Ngfary Public-ZR
tate of Florida)
Personally Kno n OR Produced Identification Personally Known f Produced Identification
Type of Identific tion Prod Type of Identification Prod .ced _
FRANCES DONZAr
` "'' CH��NIJa<A JOHNSON
MISSION ii FF 01AO7tl ,,��PR''°�'� 11II
Commission No. `-'° +` ` ES:July 27,2017 Commission No. c ° Notary P ��ic-State of Florida
;4fR BondedThruNotaryPublbUnOenrlErg °�# lP` Commission#FF 930970
9F F� 0 L 9
Bonded through National Notary Assn.
Revised 07/15/2014
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DATE
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