HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: °J _ Permit Number:
Planning and Development Ser ✓ices
Building and Code .Regulation Division
2300 Virginia Avenue, Fort Pierce FL 3498
Phone: (772) 462-1553 Fax: (772) 462-=578 Commercial Residential
FERMI I APPLICAI IUN FUR: To Select from dropbox, click arrow at the end of line
PRUPOSED IMNRUVEMEN I LUCAIION:
Address: t o cc>i< "�CL-
Legal Description:
Property Tax ID P: Lot Na. — Site Plan Name: Block No.
Project Name: _
Setbacks Front Back: Right Side: _ Left Side:
UE I AILED DESCKIP I ION OF WORK:
t //zGr�". r ag-e ms l�; tc� ��n Ps e o c �h
CONSTRUCTION INFORMATION:
Additional-iivork-to be erformed under this permit -, check ail t apply.
AC Gas Tank ❑Gas Piping __ Shutters Windows/Doors
Electric U Plumbing Sprinklers 'El Generator L1 Roof Roof pitch
Tota'. Sq. Ft of Construction:
Cost of Construction: $ 7_50S _
OWNER/LESSEE:
Sq. Ft, of First Floor: —
Utilities: Sewer Septic
Name T03rC. Y( -'Cd
Address: (cif �c��CCx PCZ.
City: P;Csrle (- State:��
Zip Code: a- Ae 1(;� Z Fax:
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page( if different
from the Owner listed above)
CONTRACTOR:
Building Height:
Name: CUVCTI S 's-A41Pv\C0S
Company: Cc 3rop A , r- vI s tems rtrc.
Address: 105 S E �/l l CCG -_C � reei1 Q
City: f7e 2r St . C uc(State: ('L
Zi p Code: s3 -+q 571- Fax: 711,2- J .3 q (n c"
Phone No. -/,I I a 3 S - 3.2 3 )-
E -Mail:_ CL .5t C., Sys .E QA -(('VM
State or County License: � 4 C C, 5 ( F I C)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
5UPPLEM EN I AL CONS I KUC: I ION LIEN LAW INFUKMA I IUN:
DESIGNER/ENGINEER: _ Not Applicable I MORTGAGE COMPANY: _ Not Applicable
Name: _
Address:
City:
Zip:
Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address: _
City: _
Zip: Phone: _
State
Not Applicable
Name:
Address:
City: _State:
Zip: Phone:
BONDING COMPANY:
Name:
Address: _
City:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
__Not Applicable
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 1 will, in all respects, perform the work
in accordance with the approved pians, 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 reco;rdina vour Notice of Commencement.
Signature of Owner
as Agent for Owner
STATE OF FLORIDA (Y
COUNTY OF P 4uel e
The forgoing instrument was acknowledged before me
this day of ���T_, 20 n bV
Signature of Contractor/License Holder
STATE OF FLORIDA (' /
COUNTY OF
The forgoing instrument was acknowledged before me
this __:]_day of \y\��= 20 0 by
v
eu r b S fYl Mori S" r2T 15 s n rn Mori 3.
(Name of person acknowledging ) (Name of person acknowledging)
(Signature of Notary Public- State of Fl a )
Personally Known ✓/ OR Produced Identification
Type of Identification Produced_
Commission No.6i l l/"'( 0:5� 116 rc��a��i�
* +
Revised 07/15/2014
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE ------
COM PLETE
INITIALS
(Signature of Notary Public- Stat of Flori
Personally Known OR Produced Identification
Type of Identification Produced �) /
�r 0 5 � rUy�
CHRISTINE BENOt�Hutiission No. t;1 1r' � �?• ' .
MY COMMISSION XG 052548
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EXPIRES: April ,2021 r p + r
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Banded Tlw Budget Ndary Servicee * * My COMMISSION X GG 052548
*A EXPIRES: 14, 2021
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION SEATURTLE
REVIEW REVIEW
MANGROVE
REVIEW
052546
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