HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: / 7 Permit Number:
•
omiloing rerma Applicavon
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 !,"y
PERM I APPLICA I IUN FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVtM1=N I LU1CA�I ION:
`Address-
Legal Description:
Property Tax ID #: 7 vC 7 c�L�GT� �L Lot No.
Block No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
UE I Al LEU UESCKIP 110N UH WO RK:
CONSTRUCTION INFORMATION:
rmea under
HVAC Ll Gas Tank
Electric 0 Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $3'Z 7
OWNER/LESSEE:
NaW
j�/
cc• / 7/ � /
City:
this permit = cmc -k aiT- appy ---
❑Gas Piping Shutters aWindows/Doors
11 Sprinklers o Generator 1-1 Roof Roof pitch
Sq. Ft. of First Floor:
Utilities: L_ Sewer Septic Building Height:
CONTRACTOR: T -
Zip Code: �� �� Fax:
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: L..' VL 4-A6ko'\CnS
Company: C ut 5 -TG rpt' / %� r ? �4 S P;'►'l 1 rL c�
Address: i k 15 S E
City: ORT St. Lucite J State: —
Zip Code:-�t 452 Fax: 7'7i I c
Phone No. 7 3 3 S` `�' 2 3
E -Mail: Cu �tc�tr sus lzc� Cc.vrc
State or County License: r� C C-' 51 'SC
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
EMENLC:UNSIRUC HON LIEN LAW INI-URMAIIUN:
EDES1GNER/_ENG:1NE_ER:— Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:s:
Address: 1
City: State: i
State:
City'
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address: �
Address:
i
City:
Zip: Phone:
City:
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 the permit holder to build the subject structure
alprohibit such
v de d for ns maor
striucture. Please consult with your Home Owers Association and revie your any restrict which
in consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
the Florida Building Codes and St. Lucie County Amendments.
in accordance with the approved plans,
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
and accessory uses to another non-residential use
accessory structures, swimming pools, fences, walls, signs, screen rooms
WARN ING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
Commencement must be recorded and posted on the jobsite
improvements to your property. A Notice of
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
Signature of owner/ essee/Contractor as Agent for Owner Signature of Contrac r/License Holder
STATE OF FLORIDA // STATE OF FLORIDA
U C l e COUNTY OF �f �JL_/ P.
COUNTY OF .C.
The €or oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 17 by this day of JUL ZO 17. by
- LSU r t I S ��� rn wton S' '�a IZTI S �J� Yr1 vhy n S
(Name of person acknowledging (Name of person acknowledging) j
i
Public- State of FI (Signature of Notary Public- Stat of Flori
(Signature of Notary ea)
PersonallyKnown > / OR Produced Identification �!
Personally Known ix OR Produced Identification
Type of Identification Produced/
Type of Identification Produced
�1 ✓ `f " M~ :-`'
Commission No. to U1 D S 7 C a'(` t SNE B emission No. rJ
MYCOMMI ,"0 GG 052516
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t' EXPIRES.A0 .2021
-- ��0t 7Hu B��dpM Nday S�wlor " '
tti BawNd MY COMMISSION 6 GO 052516
Revised 07/15/2014�`o� os:Aprr4,2ort
REVIEWS FRONT ZONING SUPERVISOR I PLANS VEGETATION SEATURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW
COUNTER REVIEW
f
DATE
COMPLETE
INITIALS
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