HomeMy WebLinkAboutpermit applicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: y- Zy Permit Number:
auiming vermis Appillcavon
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 4062-1553 Fax: (772) 462-1578 Commercial Residential v
PEKMI I APPLICA I IUN FUR: To Select from dropbox, click arrow at the end of line
PRUPOSEU IMPROVEMEN I LOCAI ION:
Address:
Legal Description:
Property Tax ID ft: LA 2- Ut"`4 " L,%LAlo - CX'-' _ 1 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
UE f AILEU UESCRiP I ION OF WORK:
LKe- �cr L�\<.2 3 Taco Iy `7ee-�
CONSTRUCTION INFORMATION:
Additionaf-work to be berformed under this permit check afl apply
HVAC Q Gas Tank ❑Gas Piping Shutters Windows/Doors
Electric F]Plumbing Sprinklers El Generator l Roof Roof aitch
Tota: Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 3 Ct Utilities: []Sewer ElSeptic Building Height: _
OWNER/LESSEE: CONTRACTOR:
Name John' Cinch-Tier-nev Name: l L' LT1 S ,SArLtN'�OnS
Address: Dc"ho—k- 2Ld Company: 0u37om A, r 5s.i s �eou iuc,
City: &C'i 5'c we-'e State: 1` - Address: 14715 'S E
Zi p Co de: ,3 4 9 2 Fax: City: (507T 9t • C- u c (t- J tj State -
Phone No. -A'1z - yS55- (s,' l 9 Zip Code:_ 3+q5,1_ Fax: `7'7,,?-
r-Mail: _ Phone No. 7,ga, 33S ' 3z3 2
Fill in fee simple Title Holder on next page ( if different E-Mail: _ u 5 t I r
from the Owner listed above) State or County License:
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENIALCONS IRUC IION LIEN LAW INFORMAIION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone:
Zip: Phone:
i
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable j
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
WARN ING 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.
Signature of Owner/Lessee/Contractor as Agent for Owner I Signature of
Holder
STATE OF FLORIDASTATE OF FLORIDA
COUNTY OF J-( 4' U CF l e COUNTY OF LS z Z UG/ -e. —
The forgoing instrument was acknowledged before mei The forgoing instrument was acknowledged before me
PS'
this day of Alc. 20 Lei by I{ this R 4/ day of 4Plei4- 20 �'-1 by
> p
- eurbs �igmmvr7S I L IZ 1 5 Slimtmorl S.
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public- State of FI ea )
Personally Known OR Produced Identification
Type of Identification Produced
(Si Public- Stat oe"f Flor'
VT
(Signature of Notary
Personally Known OR Produced Identification
Type of Identification Produced
Commission No. 01010 5J � 7 � :4a CHRISTINEBE"mission No. V1 0 D of S`1 �%� *+� *per+; -a.. pwl
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MY COMION # RG 052616
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MISS
w D IFIRES: Aodl 4.2021
?o►nor 6onleaTtn,a &-1 Plow, S-n4c
Re--ised 0-1/15/2014
* MY COMMISSION t GG ome
F EXPIRES: APr1 b 2021
REVIEWS
FRONT ZONING = SUPERVISOR PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER REVIEW REVIEW REVIEW
REVIEW
REVIEW
REVIEW
DATE
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COMPLETE
INITIALS
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