HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: x1/0 -/7 Permit Number:
ouilaing rermit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 452-1553 Fax: (772) 462-1578 Commercial Residential
PF-KMI I APPLICAI ION FOR: To Select from dropbox, click arrow at the end of line
YHOpUSED IMNROVEMEN I LUCAI ION:
Address: 2 6a2 9//n/11 / A- ---
Legal Description:
Property Tax ID 9: 'Id s-- Ito/ e40- iOe / Lot No. —
S'te Plan: Name: Block, No. _
Project Name:
Setbacks Front Back: Right Side: Left Side:
DE I AILED DESCRIN I ION OF WORK:
S 5,r
*,Vw...iSI 2'��^, /5 Secr , 6h'v► LiJte Jzsr GI/c� � Qac
,Sys'i'ca�- .� Z• .Z •r�C'•,n. , !!S'��, l ° k«� L/6t� �f J;IK� �,.r�L o�
CONSTRUCTION INFORMATION:
r lona war o be er rime un er is perms - c ec a appy:
HVAC MGas Tank F]Gas Piping —Shutters L_ -_i Windows/Doors
11 Electric El Plumbing Sprinklers Generator Roof Roof pitch
Tota Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 7.3 75 r Utilities: ElSewer []Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name
Address: r)LZ 8 i rn i n' Dr
City: r,0 P P I -e r'(_C� State: �L
Zip Code: 34449 Fax:
Phone No.
E -Mail: Ka fi; o 1,41im io L f) So u
FII in fee simplettle Holder on next page ( If different
from the Owner listed above)
Name: CU IC -r i S YA r1+ M0115
Company: L-ro rK A% r S eyKs N c
Address: I to 15 S 6 \/I I 1 cra e Q r ee rt Q
City; IPD P -T 9t . j_ u c, g�_ State:
Zip Code: 3+152-- Fax: 'i j.3�S-I9 6
Phone No. 'I'll 335`32 -32-
E -Mail.,
3S -32 -32-
E -Mail: ';° 1.1 s t a- r Sys .p a o I C G vin
State or County License: C R CC 5 ( F ( (-)
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 INFOKMA I ION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: State:
State:
City:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
i Zip: Phone: i
Zip: Phone:
I 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
that may restrict or pply prohibit such
�andon r aws or or
swhich is in tructure. Pleasecconsult rw anyapplicableany est ctions which may acovenants
Owers Associationrs ev ew your deed
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
the Florida Building Codes and St. Lucie County Amendments.
in accordance with the approved pians,
The following building permit applications are exemptfrom undergoing a full concurrency review: room additions,
rooms and accessory uses to another non-residential use
accessory structures, swimming pools, fences, walls, signs, screen
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
Commencement must be recorded and posted on the jobsite
improvements to your property. A Notice of
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or rec ding your Notice of Commencement.
Signature of Owner/ essee/Contractor as Agent for Owner Signature of Contra or/License Holder
STATE OF FLORIDA STATE OF FLORIDA
U C` 1 e COUNTY OF
COUNTY OF ,C
iThe forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
A PR rc- 20 � 7 by
this I c day of A r �I 20 i _bt this IG day of
r� m oti1G% ;1
04 S, CZ 7-1 5 -5
(Name of person: acknowledging } (Name of person acknowledging)
�'�,GFit Z'1L�i
Public- State of Fl. a } (Signature of Notary Public- Stat of Flori
(Signature of Notary
Identification
Personally Known ✓ OR Produced Identification Personally KnownOR Produced
Type of Identification Produced
Type of Identification Produced /r,1, (/ rP� CHR*TW! �?
rr Y'Pu� �l oC "�
CHRISTINEB 1mission No. v, V
Commission No. U1 G7 �n� Lf 6 :d� ;..
.
4,
EMRES W 2921
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* * MY COMMISSION # GG 05M
Revised 07/15/2014 ��� EXPIRES: April 4,2021
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW
COUNTER REVIEW REVIEW
[DATEOMPLETE
INITIALS i