HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: l }'is Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 Residential
Phone:(772)462-1553 Fax: (772) 462-1578 Commercial
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
/
Address: � &/ oy- �r
Legal Description: 7 oC 511-12 A� I2
Property Tax ID #: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
revs+c.\l 3/y J4r- 4.:'�A� 4 Ti�^•"1 e�\j'.rYn\ +Ute a�Mp �Ga+�¢.i �-tr :\�LiD f-� C.t� U'.,TK't'
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CONSTRUCTION INFORMATION:
Mona work to 6e peter Orme un e. a „s permit - cF-ecrc—ant at app y:
_ HVAC _ Gas Tank _ Gas Piping _ Shutters —Windows/Doors
i/Electric _Plumbing _5prinklers Generator _Roof Roof pitch
Total Sq. tt or construction: c,t- rt- of First Floor-
oorCost
Costof Construction: $ - Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:
CONTRAcrOR:
Name
1 i
Name: `� -�r✓r, Vt/
Address: c%Oa �a� Lir r�
Company:_ a�,1�-SCI_
City: nig ,L state: /t/-J
Zip Code: L22 0 Fax: N%y+
Phone No. i312 570—
Address: Gf /� prY,55�pf (.st
City: rt P, 2l(j( State:
Zip Code: 5V9 $ A Fax:
Phone No. I���gSa
&-OeLn (2 Q n 11Af� t Atf
LE-Mail:
F,1111a in fee simple Title Halder on next page ( if different
the Owner listed above)
E-Mail: G,)dhQ i nt,iom
State or county License: 06:79-7value
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
i
Name:
Name:
Address:
Address: I
City: State:
City: State:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLEHOLDER: _ 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
is in Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
which conflict with any applicable
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.
S
Si - essee/Contractor as Agent for Owner Sign of C License Holder
E OF FLORIDA OF FLORIDA
COUNTYOF S'/ . LL'tC� 2- COUNTYOF 'V, Lt lCr •e
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this y 'oda. of �,rern es . 20(�by this day of %�°i;mLx� .20 f by
�^
(Name of person acknowledging) (Name of person acknowledging)
,a
,Oignature of Notary Public- State of Florida } ( nature of Notary Public- State of Florida)
Personally Known OR Produced Identification Personally KnowiY OR Produced Identificationo
—c,-'
Type of Identification Produced Type of Identification Produced
Commission No.Vl✓% &o 5LIL (Seal) Commission No. P"165S . , (Seal)
a�
,NISI
JASON N RAULERSUN J
Revised 07/15/20 buy PtAtic . S4w d FloriCa a� S. ON AIR E 0
Commission N FF 965sm P
omm. E
piles Feb 28. 202C
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