HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:�7 / Permit Number:
IC aiming Yerlr n iAppiici von
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 _
PEKMI I APPLICA I ION I -OK: To Select from dropbox, click arrow at the end of line
PROPOSED IMPKOVI=M_bN I LOCAI ION:
Address:: 4t'I3 ('141111nelt,
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front Back:
UE I AILED DESCKIP I ION OF WORK:
Right Side
G ke len /..,' ke
Left Side:
/o 1w IU4_
CONSTRUCTION INFORMATION:
Additional work td be erfdrmed under tris permit ciiedk'ail appT
ny:
HVAC F] Gas Tank ❑Gas Piping Shutters
11 1z
HVAC
11 Plumbing 11 Sprinklers 12 Generator
Total Sq. Ft of Construction: _
Cost of Construction: $ d . �7 _
OWNER/LESSEE:
Name Ro 't Q /1?Ctjaa ic'Z �'z m a" ll
Address: of 206a- i E
Sq. Ft. of First Floor:
Utilities: []Sewer F Septic
City: A, 7 )Y L";- _ State: FL
Zip Code:Fax:
Phone No. %'Af V- 'Y1,Y
E -Mail:
Fill In fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Lot No.
Block No.
QWindows/Doors
0 Roof Roof pitch
Building Height:
Name:Gi;cc7rblmcr,
Company: Cus-rom A %r Ssi;tevKs lN(�
Address: 1&,t5 S E \/,I I reerl
City: POP -T- 9t. Loci e; —�� State: r�—
Zip Code: _ Tg152-- Fax: 7%2. j35-Ig6�
Phone No. '7 `7 a- 3 3:5- -- 3.2 3 �)-
E -Mail: q StaIr Sys CC0� C6VYL _
State or County License: Ct CO 5 18 1 (
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENIALCONS IRUC IION LIEN LAW INFORMAIION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: _ Not: Applicable
Name:
Name: I
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:
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 exempt from 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 rec ding your Notice of Commencement.
s
Signature of Owner/ essee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDAr STATE OF FLORIDA
COUNTY OF
COUNTY OF >J 2� U C` l E
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this d7 day of A 10'e 20 / 7 by this day of �/°�i �- 20 by
- Liu r i` I S � 14 M man S u rZTl S gn m mo r1 S
(Name of person acknowledging) (Name of person acknowledging)
01
• / �--/
Stat Flor'
Si ature of Not Public- of
(Signature of Notary Public- State of FI a) Im ry
Known OR Produced Identification
Personally Known OR Produced Identification Personally
Type of identification Produced Type of Identification Produced
Commission No. n * #
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Re-v•ised 07/15/2014 'a `oma Do s:Ap ill 2 1
i
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
i
INITIALS
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