HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �� �D "� 7 Permit Number:
ouliming Fermin A(JF711CdT10n
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
NEKMI I APPLICA I IUN FUR: To Select from dropbox, click arrow at the end of line
PKUPUSEU IMPRUVEMENI LUC:AIIUN:
Address: %G�6S /}%C'�in�o�k l✓acy
Legal Description;:
Property Tax ID ##: '7 Z 7 -dpw-(;D7'0
S°te Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
DEIAILED UESCKINIIUN UF- WURK:
Lot No.
Block No.
/'0IL4./
[CONSTRUCTION INFORMATION:
Additional-workto be pertorme-d un3erthis permit cK-eckaii uaj apply:
HVAC F—IGas Tank ❑Gas Piping Shutters F—lWindows/Doors
Electric Plumbing Sprinklers Generator Ll Roof F Roof pitch
Tota: Sq. Ft of Construction.: Sq. Ft. of First Floor:
Cost of Construction: $ y��` Utiiities: 0 Sewer F] Septic Building Height:
OWNER/LESSEE:
Name Jekn dUeberah Gari Ile
Address: Ila b S M1e.Cl.inlock WA4
City: poQ-r Sz Lgci-e- J State: rL
Zip Code: J45a- Fax:
Phone No. 77)-173 -DOy I
E -Mail:
Fill in fee simple Title Holder on next page { if different
from the Owner listed above)
CONTRACTOR:
Name: 6UVCT IS ,YAaVActlS
Company: CZ ,5-ro -t A %r S4stems {iUc
Address: 14,15 S E Ali 11 Qa-e �reen O r'
City: Po R -T- 9t . L uct f—I J State: r--
ZipCode: 3-'452-- Fax 77,x- J3.5 -196Y
Phone No. `Tq1 33S - 3.2.3 2
E -Mail: Cu St&ir Sys .P aol•Covm
State or County License: CC? 5 { 8 ( O
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEM EN I AL CONS I RUC I ION LIEN LAW INFORMA I ION:
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 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 exemptfrom 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 Owner/Lessee/Contractor as Agent for Owner Signature of Contra r/License Holder
STATE OF FLORIDA /
COUNTY OF X � /_ U L'- / a°
The forgoing instrument was acknowledged before n-mee
this to day of A Pae 20 i 7 by
- eu r 6 s �n fil mon s'
(Name of person acknowledging )
STATE OF FLORIDA /
COUNTY OF
The forgoing instrument was acknowledged before me
this �( day of A R Rn- , 20 17 by
Chu Q T 15 stl m mo ri 5
(Name of person acknowledging)
/ ' if
-14-4(Signature of Notary Public- State of FI a Si ature of Nota Public- Stat/offlo/ri
C Y / ) ( En rY
Personally Known ✓_ OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
/, / �r 0 5 �Sy �' ra� tHRt�Twtiw ..
Commission No. (11 Snc W7 rP BD mission No.
Revised 07/15/2014
REVIEWS FRONT
COUNTER
DATE
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INITIALS
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ZONING SUPERVISOR I PLANS
VEGETATION
SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW
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