HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2 � -� / Permit Number:
J
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csuiming rermix Appiicavon
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 /
Phone: (772) 462-2553 Fax: (772) 462-3578 Commercial Residential
PhKMI I APPLICA I ION I -UK: To Select from dropbox, click arrow at the end of line
PROPOSED IMPKOVEMEN I LOCA I {ON:
Address:
Legal Description:
Property Tax ID #: 3401- (q l V - O U7 000, ,y Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back:
UE i AILED DESCRIP i ION OF WORK:
, Q 9 'id 7-
Right Side: Left Side:
Block No.
CONSTRUCTION INFORMATION:
Ail i;ti
onal'w-76-rTTo nGasTank
�me un er this permit — c ec a app y:
HVAC DG -as Piping _ Shutters Q Windows/Doors
11 Electric 1i Plumbing OSprinklers 1:1 Generator F1 Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ J A i`o Utilities: 0 Sewer U Septic Building Height;
OWNER/LESSEE:
Name ��55 i ca- K n ( e r1
Address: 5711 (� e��_oc� ry ►�/i> -
city: 1 a tit, ply, _ State: P71
-7
Zip Code: J4 8 Fax:
Phone No. 94G -
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name: C L' 1t T (` f3 riA 641 G r1 S
Cam pany: 3 r nti /� r S `► s ei� S (n c,
Address- li/l I 1 ItQ -f r• ee n,
City:
Pv R r
9t. 1` c i c State:
Zip Code: 3-+459 Fax: 77�.j-35-i9&-,r
Phone No. T1 1 3 3:5'
3 2 3
E -Mail: C L( a t cti l r S y—E cc c l c c vn
State or County License: Ct co 519 / 0
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENIALCONS IRUC IION LIEN LAW INFOKMAIION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: — Not Applicable
Name:
Name: !
Address:
State:
Address: j
City: State:
City:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name: i
Address:
Address: 1
City:
Zip: Phone:
city:
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
in conflict with any, applicable Home Owners Association rules, bylaws or and covenants that may restrict y such
rprohibit
which is apply.
structure. Please consult with your Home Owners Association and review your deed for any restrictions which ma
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 exemptfrom 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 rec , ding your Notice of Commencement.
s
Signature of Owner/ essee/Contractor as Agent for Owner Signature of Contractor/License Holder
i
STATE OF FLORIDA STATE OF FLORIDA
�� U C' i e COUNTY OF_ �fy U 2 I
COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
by
this 5_ day of Qa�i 20 / 7 by this J day of %> 120
mOn S' eu rZTI S �Jl� m ata ✓1 S
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public- State of Fi a) (Signature of Notary Public- Stat 4FIori
Personally Known ' OR Produced Identification
Personally Known OR Produced Identification
Type of identification Produced
Type of Identification Produced
/+ nC
Commission No. Q Lf 6 Y P CHiIM E B vnission No.
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Rex-ised 07/15/3014 11 Apd4,2021
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REVIEWS FRONT ZONING SUPERVISOR PLANS [ VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW ' REVIEW REVIEW REVIEW
DATE
COMPLETE
i
INITIALS --
0