HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE 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 6
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 7y/��
p�1t1�0�/
�orfqq P,'e�«
, �/ 3795/
Legal Description:
Z4keWdral
P4r� ftcbcYi/iny
N6 - (3L,k/ f) LDT /4 �4i 39 737a
Address: 233y`W V3�;4��piJ 5*ee�
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Company: CXG�SjDr />�tJSf/Y�CI
Property Tax ID #: 130d-- g/D - (06gy -1m59-9 Lot No. /9
Site Plan Name: Lq1z1'1n0'1 P0(4 Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
e� ove Gl �d rep Iq cc q' x 7 ' 8,1 rq Je door W A Ne W
CONSTRUCTION INFORMATION:
Additional work to be Derformed under this permit — check all That apply: /
❑HVAC Gas Tank []Gas Piping O�' Shutters EWindows/Doors
Electric Plumbing Sprinklers 0Generator 11 Roof Roof pitch
Total Sq. Ft of Construction: J/ Sq. Ft. of First Floor: 36,0
Cost of Construction: $ 7DO Utilities:LiSewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name LACUu nNe Ze.51 'e
Name: /& 'N
C&Sz
Address: 233y`W V3�;4��piJ 5*ee�
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Company: CXG�SjDr />�tJSf/Y�CI
i6N �JCITi�
City: Pol 51, LCecik_ State: _E�
Zip Code: 3Kg53- - '5 Fax:
Phone No.
Address: 16?d SE Gr�W
rrV
�I i✓P
City: Pol+ N. Lurie
Zip Code: 3;gg03
Phone No. 7_)a - Y/ - '
Fax:
State: rL
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E -Mail: /<evin7r LxCe 5�o�coNS�/Yrcti�N,iVP�
State or County License:
It value of construction is 52500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: ri Not Applicable---
pplicable--Name:
Name:
Address:
Address: -
City: - " " State:
Zip: _--Phone:
City: -" State:
Zip: J -----Phone:
FEE SIMPLE TITLE HOLDER: ✓ Not Applicable
Name: =
Address: - '
BONDING COMPANY: l' Not Applicable
Name: --
Address:
City:
City:
Zip: ?IKone:
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 your Notice of Commencement.
S
Signature of er/Le ee/Contractor as Agent for Owner Signature of ContracWLicenolder
STATE OF FLORIDA STATE OF FLORIDA
COUNTYOF St. Lucie �COLINTYOF Zztc/,�-
The forgoing instrument was acknowledged before me
this 36� day of Aiuuenibe_c- , 20 Lby
(Naniie of pe
ng)
of Notary PubllJ6 Staff of Florida )
Personally Known y' OR Produced Identification
Type of Identification Produced
Commission No. F?� 735/78
Revised 07/15/2014
The forgoing instrument wasacknowledged before me
this F(A day of kweA4ec 20 IG by
of pOrson 4cknowre¢'gi6g )
of Notary Public- S(atee-of'Florida )
Personally Known / OR Produced Identification
Type of Identification Produced
LYNN ASWARTZEL _-Ci5lriission No.
MY COMMISSION k FF 93 119
30 21020
Bonded Thru Notary Public Underadters
LYNN A SWARTZEL
MY COMMISSION M FF 93
Wded Thor Notary pubic
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