HomeMy WebLinkAboutBUILDING PERMIT ,pMCABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: -J_ r� Permit Number.
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,fort Pierce FL 34982 Residential
Phone: (772)462-1553 Fax: (772)462-1578 Commercial
PERMIT APPLICATION FOR:
Address:
Legal Description:
Lot No.
Property Tax ID#: yy ��" !��- %-�['
Block No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side:_Left Side:
j0/1,,✓
AddftFo-nal work PerrOrmeO un er Is perm —c e a app .
Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ y S^j Utilities: _,Sewer _Septic Building Height:
Name C
+gL Ott m ��e hin bock— Name: Cur f t 5 Savn m on S —
tJ vJ �� � Company: r r Air
Address: «�► 6 5 �'State: F-L p Y: l(�l S $E I r I�
Address:
City: — oQ-r �T LAC�� State: �L.
Zip Code: �4 q' Fax. Cam:
o p 34t -o2, Fax: `17; 33S )�L
Phone No. `77� 38C T Code:y� � �
E-Mail: Phone No. 1,7
Fill in fee simple Title Holder on next page(if different E-Mail: '-u sto,xr, 4S °)
from the Owner fisted above) State or County License: Cfl C 0 5 I R IO ' S �
If value of construction is 2WOr more,a RECORDED Notice of Commencement is required_
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SUPPLEMENIAL CONS IRUC;IION LIEN LAW INFORMAIION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone: I
i
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
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 rec , ding your Notice of Commencement.
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Signature of Owner/ essee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF j� 4 U e I e_ COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 5 day of J 0 rj 20 Eby this 5 day of ETl(1>1 20 j by
i
- curds �Igf7i Mori S' �nmMOYA S I
(Name of person acknowledging) (Name of person acknowledging)
I
(Signature of Notary Public-State of FI a) (Signature of Notary Public-State/of Flori j
Personally Known ✓ OR Produced Identification Personafly Known ✓ OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. Ala , CHRISM59 eMmission No. U? M0�o[✓`1 �%' ` M�;:�:. 101011111
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Revised 07/15/2014 *J%Ai,► My COMMISSM#000sm
`ate EXPIRES:April 4,2021
REVIEWS FRONT ZONING SUPERVISOR j PLANS I VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW + REVIEW ? REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS