HomeMy WebLinkAboutBuilding Permit ApplicationMLL nt t-U1,AULt INFO MUST HE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
Building Permit a nHt,-=ta®l
Planning and Deveiopmentser, &s
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce Ft 34952
Phone: (712) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Commercial Residential .V
To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:'
Address:
Legal Description: "j irk c
Property Tax ID #: f
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
f NE
Lot No.
Block No,
CONSTRUCTION INFORMATION:
A itrona
Milk to 5IT 111i un er t is cnecR all t a app y:
FIVAC L _J Gas Tank Gas Piping Shutters Windows/Doors
L=l
Electric Q Plumbing Sprinklers LJ Generator 1:1 Roof
Total Sq. Ft of Construction:
Cost of Construction: $ ,SS -6
OWNERf LESSEE
SFt. of First Floor_ _
UtilitiesSewer 0Septic
Name
Address: �- C
City: State: RL
Zip Cor�de��Fax:
Phone No.
E -Mail:
Fill in fee simple Title Holder on next Page ( if different
from the Owner listed above)
Building Height:
CONTRACTOR:
Name:D
Company: G e *ti0rVA \' ct'L.
Address: lqo SC
City: 176 ` , l Lf clt State:
Zip Code: aZ Fax: 2? . 335- D 9
Phone No. 1-12.— 3*,27-- 3(, ' Z
E -Mail: Gen 5ls`?kyr loi'\ Sar-Vkc
State or County License:
25-f —V
y 6 ry —
If value of consiructiort is $25110 or mare, a RECORpEp Notice of [ommer►cement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: i Not Applicable
Name:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
Address.
City: State:
Zip: Phone:
City: State:
Zip: Phone -
FEE SIMPLE TITLE MOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
[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 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.
re of
as Agent for Owner
STATE OF FL A
COUNTY OF -�,�
The fprgoing instrul3ient was acknowledged efore me
this day of20 1 y
re of Contractor
STATE OF FL DA
COUNTY OF , (
The f r Ding instru ent was acknowledged before me
this day of 20 Q_ by
(Name of person acknowledging ) (Name of person a knowledging )
(Signatire of Notary Publi:OR
ate of Florida )
Personally Known l Produced Identification
Type of Identification Produce
+?""•g MARIAH MILLS
Commission No. ( F l ission#FF 023763
�oF Expires June 3, 2017
6pkf d lu im Fain Insurance em'8�7019
Revised 07/15/2014
(Signat re of Notary Public- ate of Florida)
Personally Known ': OR Produced Identification
Type of Identification Produced �...� ,..,. »...,._ ..__
. 4 MARIAH MILL
Commission No, ; (Sre'n� s�onFFO�"G3
kxpides June 9 2017
1+,r1 it r Fair lRsu�an c ENS atl+iU1?
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INITIALS