HomeMy WebLinkAboutpermit applicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 5- 1s - � 1
Permit Number:
lowilaing rermn Appicazllon
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
Ni-KMI I APPLICA I ION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMF-NI LOCA IION:
Address: e .• r
Legal Description:
Property Tax ID #: LA Lk Z (0 - g LI b + 0062 C� " (p Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back:
L)t I AILtU UtSCKIP i ION OF WORK:
Right Side: Left Side:
U Ke. mor \�%e. oron N-5 eer iJr,:
Block No.
CONSTRUCTION INFORMATION:
i
AdditTworTc�to-ti(-- erformed under
H(VAC Gas Tank
11 Electric r_1 Plumbing
this permit - ehii k aTf� appTy--"-
OGas Piping Shutters
Sprinklers [:] Generator
—a----
Q Windows/Doors
F]Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ L oQQ5
OWNERAESSEE:
Sq. Ft. of First Floor: _
Utilities: 0Sewer F]Septic
Name'XiClhcfd 0DlorC9 Kie.l�Ot>
Address:- ►Leri @ NL�_&> [3 t k_yn ugh C :r -
City PO.ArA wn4 State: FL,,
Zip Code: 3�kctg0 Fax:
Phone No. 1ri�.',3 4Lk-• I (lolp
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR.
Building Height:
Name: C U tMT FSA it tMc rn S
Com pang: Cu 3To rK A 5 S em, I ro c
Address: l 4' I S SE �11l I dq _e !Lr ee i1
City: (c� 2t St . C uCi e__ State: r�-
Zip Code: 3.q_g52 Fax: J .35-(9 6W
Phone No. '72a. 33:5--3a32-
E-Mail:
3S -3a32 -
E -Mail: _CLi st&ir s y s .p ac, c[vYt
State or County License: � 4 co 5 e/ O
_ ____.__ .. _ _._ . . __..... ___ .
I value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMEN IAL CONS I RUC ION LIEN LAW INFORMAI IUN:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: _ Not Applicable j
Name:
Name:
Address:
Address:
City: State: '
City: State:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable j
Name:
Name:
Address:
Address:
City:
City: I
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 recpfding your Notice of Commencement.
- S
Signature of Owner essee/Contractor as Agent for Owner
Signature of Contra r/License Holder
i
STATE OF FLORIDAr /
COUNTY OF J t 4 U e 1 e
STATE OF FLORIDA
COUNTY OF LS L U e/ �.
The for Ding instrument was acknowledged before me
this day of ��, 20 \ 1 by
The forgoing instrument was acknowledged before me
this \�j day of 20 \ ^( by
'
- curds *14mmoil S
J
eul2TI S SnmmoYA 5 -
(Name of person acknowledging }
(Name of person acknowledging)
(Signature of Notary Public- State of FI ea }
Personally Known _✓ OR Produced Identification
(Signature of Notary Public- Stat of Fiori
Personally Known OR Produced Identification
Type of identification Produced
Type of Identification Produced
// ��/ ?
No. AN CHRISMEB
lf1 ��� Y� �
MYcoMM{S "S
—_._ ..__.______..__-.-____-��_._._EXPIRES:AyrY
0 -/15/2014 ��' 90f1(kd ihU H�
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mission No.
t9? �1 a S`1 i7UF+Commission
052546-___.__.__
,2021 _.. ..«.
$�IY�pt ��CoWt��`'��TReiised
eMS App 4, 1
I i
REVIEWS FRONT ZONING SUPERVISOR
PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW I REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS i