HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 1
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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: Alteration
PROPOSED IMPROVEMENT LOCATION i..: . ..
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Address: /1 ed7
Legal Description:
Property Tax ID#: �7 J l�-�50 � `i - ��� " ''1 Lot No.
Site Plan Name: /t , �I Block No.
Project Name: _ Chikahesl (�ti�7u"(/((ll
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION ClF WORK � �y
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M'led 40 cur re_nf� Ctr�Q . /r)� �e��l�y
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CONSTRUCTION INiFORIV(ATlON
Add workto a e` orme under
er t is permit—check a appy:
❑HVAC Gas Tank ❑Gas Pig Shutters M
/Doors
pin WindowsElectric Plumbing Sprinklers Generator Roof M7,9 Roof pitch
Total Sq. Ft of Construction: SFt.of First Floor:
a�
Cost of Construction:$ 02�� Utilities: _Sewer 0 Septic Building Height:
O;WN,ER/LESSEE :CONTRACTOR
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Name Name: ♦—
Address: (O Company: S C
City- 22�� State: F_ Address:��f I �5 � �l
Zip Cody`CFax: City: Nt&P1 State:_��
Phone No. -772 —2 3 3 - gyoS Zip Code: zWQ L Fax:'T1ac-0?&7—77&3
E-Mail: Phone No. _ra—
Fill in fee simple Title Holder on next page(if different E-Mail: C vg 65 •C6wC
from the Owner listed above) State or County k rise: / L
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LA1N'IIVF�RMATION ' flffd
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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:
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 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 recording our Notice of Commencement.
y /orl-� A s
Signature of Owner/Lessee/Contractor as Agent for Owner Signa re of Contracto License older
STATE OF FLORID �� STATE OF FLORID IA
COUNTY OF �(,rQ,f/`r��1 COUNTY
The forgoing instrument was acknowledgedefore me The forgoing instrument was acknowledged before me
this�day of 20 �by this�day of A '20 1 by
(Na'me of person acknowledgin (Name of pers n acknowledging)
(Signa re of Notary Public-Stat of F o da) (Signal re of Notary Public- a o orida)
Personally Known X" OR Produced Identification Personally Known >r OR Produced Identification
Type of Identification Produced 2 Type of Identification Produced�
Commission No. vl(o�-) (Seal) Commission No.6(& a�ucO&75 (Seal)
ttv,� #'"`P!b'REBECCA RESTIFO
Fes,
REBECCA
Revised 07/15/20IOF
MY COMMISSION#G(i9r v tn:&Cp0!"S'�'M'0: ay 17,2021
EXPIRES:May 17,2021
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS