HomeMy WebLinkAboutBuilding Permit Application,PPLICABLE INFO MUST BE COMPLETED FOR APPUCAmolwTO BE ACCEPTED
Date: S C / 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 L-'
PERMIT APPLICATION FOR:
Address:
/'/ / 1 N d1'1 w' I 6tL'�o
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Lot No.
Block No.
_Mechanical — Gas Tank _ Gas Piping _ Shutters , Windows/Doors
Electric _ Plumbing
Total Sq. Ft of Construction:
_ Sprinklers _ Generator
Sq. Ft. of First Floor:
Roof
Cost of Construction: $ 'r/2 0 Utilities: —Sewer _ Septic Building Height:
Name 1t'n3ui e
Address: f1fJ e 'W
City: d4kl l'x!'i State:
Zip Code:
Phone No.
E -Mail: r' ko rL? C, fLQ t
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: CuctlS S w on
Company: ruST&nrr, Ur SL-Ssfems NC.
Address: `V r I l ap rte- /1 1
City: 'Po k «
-r ST Lc State:
zip Code: 344_2 Fax: 97a 3 3 S_ 14b
Phone No. `l7� 3� S - 3 a3 2
E -Mail: C-Usfi r o ( -
State or County License: CAC 0 5 0? I D She
If value of construction is 2SWor more, a RECORDED Notice of Commencement is required.
I
SUPPLEMEN IAL CONS I RUC I ION LIEN LAW INFORMAI ION:
DESIGNER/ENGINEER: _Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Ad d rens:
City: State:
City: State:
Zip: Phone:
Zip: Phone:
i
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name:
Address: i
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 Countyy_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 re c ding your Notice of Commencement.
s i
Signature of Owner/ essee/Contractor as Agent for Owner Signature of Contractor/License Holder
i
STATE OF FLORIDA r STATE OF FLORIDA
COUNTY OF
COUNTY OF V U C' l e
The forgoing instrumentwas acknowledged efore me The forgoing instrument was acknowledged before me
this —� day of �� ITA _, 2� , by this 3 0 day of I�1 P. `1 , 20 by
""TT
�nmM0n S
- Liu r �.I S ��n fn mon S' 'u rLrl S J
(Name of person acknovzledging) (Name of person acknowledging)
t
(Signature of Notary Pu/blic- State of Fl a } (Signature of Notary Public- Stat of Flori
Personally Known OR Produced Identification
Personally Known ✓ OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. D S� Y° CHRISTINE BEI emission No. M :•:'
MYCOMMISSIONf 3G 052546
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EXPIRES: Apd . 2021or
0.. 04I
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Revised 07/15/2014 " ' �nrca�ss►oN�eGoo52s46
°a E)t7'IRES: Ap 14, 2021
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REVIEWS FRONT ZONING SUPERVISOR jj PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW I REVIEW REVIEW REVIEW REVIEW
DATE
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COMPLETE
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INITIALS