HomeMy WebLinkAboutBuilding Permit Application.PPLICA,�B/LE INFO MUST BE COMPLETED FOR APPLICATION' TO BE ACCEPTED
Date: / " / .7 Permit Number:
Building Permit Application
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
PERMIT APPLICATION FOR:
Address:
Legal Description:
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Property Tax ID #: ,� %�S� i� �j'–
Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
—Mechanical
Electric Electric
_ Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: 70
Name lf/i1-, lolls o� kd, q eNn 4 n 4; o z/ho
3 T Gee,ASe
_ Gas Piping
_ Sprinklers
Address: .6,eZ,�& 4� /(f/,—
City: 1110A " State:
Zip Code: J4,Z Fax:
Phone No.
E -Mail:
_ Shutters
_ Generator
Sq. Ft. of First Floor: _
Block No.
_ Windows/Doors
Roof
Utilities: _ Sewer _ Septic Building Height:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: C trtts ScLm rnon .S
Company: IsTem Lr 5�Sheins tilt
Address: I(e l S S E Ti 1letQo_ Q r en D,-
City: PO 9 T ST Lu C k� �� State: F -L
Zip Code: 342_52) Fax: `77a 33S ) 9,�
Phone No. 771 33S -3z32-
E-Mail: C4S101kr Su V ao •l.rn
State or County License: CAC 0 5 )9/0 540te-
If value of construction is 2SWor more, a RECORDED Notice of Commencement is required.
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SUPPLEMEN I AL CONS I RUC I ION LIEN LAW INFORMAIION:
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:
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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 thepermit 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 re ding your Notice of Commencement.
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Signature of Owner essee/Contractor as Agent for Owner Signature of Contra r/License Holder
STATE OF FLORIDA / STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this _day of 20__by this day of20 by i
i
�rnn�anS �u12,T1 S S�mrnv;1 S
(Name of person acknowledging } (Name of person acknowledging)
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(Signature of Notary Public- State
of FI a } (Signature of Notary Public- Stat of 11or'
Personally Known ✓ OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. U 1 5 Yb Y1 CHRISTH�EB mission No -9405150
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EXPIRES: .2021 `_it ►�_--
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Revised 07/15/2014 * JW * M'CMUSSION # 00052M
'41 :AprJ b 2021
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REVIEWS FRONT ZONING SUPERVISOR PLANS ' VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW I REVIEWREVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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