HomeMy WebLinkAboutBuilding Permit Application ALL APP.LICAB INFO M S'BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ��� Permit Number:-Ml
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Building Permit Application
Planning and Development Services
Building grid Code Regulation Division
2300.Virginia Avenue,.Fort Pierce FL 34982
Phone:(772)4624553 Fax:(:772)4624578 :Commercial Residential
PERMIT APPLICATION FOR:: "T.O Select from dropbox,:click arrow at the end.of line
PROPOSED IMPROVEMENT LOCATION:
3
Address: t n: .. �-I a n:. //e-• 2 Y'
95"
Legal Description: L-a 1-2 c�J 00� , Im r 1L i13 /o C IL... / S 3 Lot
Property Tax ID#: 1301— 4013 O3 73— 000 — Q Lot No.
Site Plan Name: Block No. I�3
Project Name: (Gro �eY-)Lc-
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION 0f WORK: .µ.
N 5TA L.-X1 A O N p <567 WKY�
w e Ve- (,l Z) R C Co V_ IJ I a rJ
CONSTRUCTION INFORMATION:
Additional work to be ertormed..under this:permit-'check all
thAapply:
HVAC Gas Tank Gas Piping Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers n—Generator E] Roof Roof pitch
Total Sq.'Ft of Construction: S . Ft.of First Floor:
Cost,ofConstruction:$Tl 'I . s� Utilities: Sewer'�Septic Building Height:
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NER/ ESSEX: CONTRACTOR
Name Noa \G YoSS Name: Mi ri o,y" voki,
Address: �' n Y_� 2 • Company: fl,V'•'� ��rr; c_o-��_5hL1'5J'
City: -2i-� State: Address:_ 3100 I1/
�• i
Zip Code: 3 Lt a S) Fax: City: - o► ► r G2� Stater
Phone No. -172 -- Zip Code: Fax: 777_-7'9 4-- IS410
E-Mail: Phone No.
Fill:in fee simple Title Holder on next page(•if'different E-Mail: �J h Barri c0�✓1�J �"�` �+'+�-Q
from the Owner listed above) State or County License: —I-
n rnanT�
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: 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 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 Twill,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.
Signature If Owner/Lessee/Contractor as Agent for Owner Signature o Contractor/ icense Holder
STATE OF FLORIDA :STATE OF FLORIDA
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COUNTY OF L C.110A`�-. COUNTY OF 1
The for���ln instru n wa a knowled ed fore me The for oing.instru ea was acknowledged before me
tf J` day of 20 y this day of 20 by
e
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(Name of person acknowledging) (Name of person acknowledging)
_a�� 1-h- iE
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ttPublic-State of Florida) (S,n to Notary P blic-State of Florida
RV PV�,, AANG LAQ� F .ally *, °-': r PFS yLC, 4a9eeloohioln�al. Personally Known OR Produced Identification
T e o _ _ $rfilR3tssie fi a ' n Produced
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DATE
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INITIALS