HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: '7. Permit Number:
•
ouliming rermi-E AppicaT< on
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 /
h
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
FERMI I APPLICA I ION FOR: To Select from dropbox, click arrow at the end of line
PKOPMEU IMPROVEMENI LUCAIION:
Address
Legal Description:
Property Tax ID #: %i�aZ �' %da `/,ZDO'OULot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
UE I AtLEU UESCKIP I ION OF WORK:
z1ka s rw
,5-k kJ
CONSTRUCTION INFORMATION:
Additiona wor obe ei�med un er is permit = c�iec ckail appy y: -
( aWindows/Doors
F]GasTank
HVAC :Gas Piping Shutters
11 Electric E] Plumbing Sprinklers Q Generator l] Roof Roof pitch
Totai Sq. Ft of Construction: Sq. Ft. of First Floor:
0
Cost of Construction: $ a 1 00 Utilities: Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name &1 111U c (pro / 6&) S Name: Ci.'VCTl S �pMIMcnS j
Address:J9e„Z /R 9� Company: Cu —ro m A , r S u S ewes (n; c, i
City: Fm i? A/ ZAu' State: Address: Z E �A I d4 r ee rx
Zip Code: J�J�G Fax: 77,2 �S-/ 9( Cit Po P - T -St . C oct State-
� Y� t_ -Phone
No. Zip Code: a+q 59. - Fax: '7%?. 'J 3X5-19 6 Y �
'7 "1 1 3 3:5-
Phone No. 3 2 3 2
E -Mail: '
Fill in fee simple Title Holder on next page ( ff different E -Mail: C u S t C' I r s s E Cr o (G vm
from the Owner fisted above) State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMEN IAL CONS I RUC I ION LIEN LAW INFORMAI ION:
DESIGN ER/ENG [NEER: _ Not Applicable
Name:
Ad d ress:
City:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
Citxr
Zip. Phone: _
State:
Not Applicable
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
city
Zi p: Phone:
Not Applicable
tate:
_Not Applicable
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
structure. Pleass'e consult W with your Hoc e Owners hers Associa ton andrrrevie bylaws
your deed or any restrictionsat which may apply fit such
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 recolyding your Notice of Commencement �__�/'1
Signature of Owner
as Agent for Owner I Signature of
STATE OF FLORIDA
COUNTY OF ��
The forgoing instrument was acknowledged before me
this /7 day of ,}PR./L— , 20 /�_by
- Crurh5 �nfnmot? S
(Name of person acknowledging )
a�
(Signature of Notary Public- State of FI a )
Personally Known _✓ OR Produced Identification
Type of Identification Produced //''//
Commission No.
a 0 S7� b MNSTM B E
Revised 07/15/3014
Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this day of PCL L 20 IJ by
& IZTI S gtl m M0 n S
(Name of person acknowledging)
(Signature of Notary Public- Stat o4F1orr*y*e
Personally Known OR Produced Identification
Type of Identification Produced
No. o
MYCOMMISSIONi vaicwv
a � _ E](PtRES:ltpri�2021
---�erw y' t�na.en.utwao�watays.nta�s
* MY COMMISSION t GO ORM
c
UPM: Apd 4, 2021
REVIEWS
t
FRONT ZONING SUPERVISOR PLANS VEGETATION
SEA TURTLE
MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS