HomeMy WebLinkAboutBuilding Permit ApplictionALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
t5mming rerma App icavon
Planning and Development Services
Building Ord Code Regulation Division
2.300 Virginia Avenue, Fort Pierce Ff .34982
Phone: (772) 462-1553 Fax- (772) 462-1578 Commercial Residential
i
PERMI I APPLICA I IUN FUR: To Select from dropbox, click arrow at the end of line i
PROPOSED Ill PROVICIMEN I LOCAJ [ON:
Address: 79-u E 5f:p- Cir
Legal Description:
Property Tax ID P:5qlCo -trO) -00,31 -OC)O
Site Plan Name;
Project Name:
Setbacks Front Back: Right Side:
L)E I AILED UlzSCRIP I ICIN 01- WORK:
Left Side:
Lot No.
Block No.
I //f C 11r IAC- Z 5- r- ttls-ce-r CXA)!Se-- oor- /0 /J
CONSTRUCTION INFORMATION:
Additionalworktobebeffidr--med Linder this p6ftniit —c p7DT.-
HVAC []Gas TankEi
7Gas Piping _Shutters Windows/Doors
EEiectric Plumbing [:]Sprinklers 11 Generator L1 Roof Roof pitch
Tota', Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ s-0 Utilities: Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name -C+ -P�obff-Fa Name: U rL t 5 'S'n ru m0 n
Address: Cc Company: C'( -(n --ro n1L A or S �.i st evil, ruc-
I
city: P6 L— State: Address: \A 11 dc,..e ti`reei�
Zip Code: LP'5-� Fax: City: PO PLT 9t - L L, c, State:
Phone No. -7 3(01 Zip Code: 0+q:�.L- Fax: 71,2- e,35-(q6�
E -Mail: Phone No. T1 a, 3.3 5- - 3,2- 3 ' )-
Fill in fee simple Title Holder on next page ( if different E -Mail: 6- L( $t C- I .� Ck01-(6VYk-
from the Owner listed above) State or County License: 0 5 f g I C)
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
UPPLEM EN IAL C:UNS I RUCHON lON LIEN LAW Ii\ll-ORMA I [UN:
DESIGNER/ENGINEER:
Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City:
State: City: State:
Zip: Phone:
Zip: Phone:
EEE SIMPLE TITLE HOLDER:
Not Applicable BONDING COMPANY: Not Applicabie
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 bolder to guild the subject structure
which is in conflict with any applicable Horne Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult with your Horne Owners Association and review your deed for any restrictions uthich may apply.
In consideration of the granting of this requested permit, I do hereby agree that f will, in all respects, perform the work
in accordance %,%qth the approved plans, the Florida Building Codes and St_ Lucie County Amendments_
The foil"Ang building permit applications are exemptfrorn 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 recp ding your Notice of Commencement.
s
Signature of Owner/Lessee Contractor as Agent for Owmer , Signature of Contraccioorf License Holder
STATE OF FLORIDA
COUNTY OF X. /—Uei e
STATE OF FLORIDA
COUNTY OF xz 1'0C/ -e.
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me j
this 7 day ofrwf i� I , 20 boy this __7 day of 20 L%by
t
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eu>^ 1 �iF7Ir�Ca11S CLrzT1 S �nrill OVA0yl S 9
(Name of person acknovAedging j (Name of person acknowledging)
�,`�of iSignature of NotaryPublic- State of Fa (Signature ofNota Public-Strf`(��_ I
Personally Known ✓ OR Produced IdentificationPersonally Known � OR Produced Identification I
Type of identification Produced _�— Type of Identification Produced j
�!/ SPR; PUBS GHRIS`.N' ; �,r JSH
Commission NO_ IJi7 t4 � '7r! CIiRISTINEBi t ti�n�issian No. l?l L7 {✓'7
* MY COMMISSION # sG 052546
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Reirised 0"17/15/2014
REVIEWS FRONT ZONING ? SUPERVISOR
COUNTER REVIEW REVIEW
DATE - COMPLETE 1
INITIALS i
* My COMMISSION $ GG V4M
®Yra �ot EXPIRES: Apni 4, 2021
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PLANS 'VEGETATION SEA T LIRTLE MANGROVE
REVIEW REVIEW REVIEW REVIFEW