HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: rl Zg— t-1 Permit Number:
s
ounaing rermit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 j
Phone: (772) 452-1553 Fax: (772) 462-2578 Commercial Residential 4
PROPOSED IMPKOVEMEN I LOCAI ION: _..._...._._....
Address:
Legal Description:
Property Tax ID #: ca4V P — :5 b t — M 1 & - 0 C)b — 1 Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
DEIAILED DESCKIPIION OF WOKK:
YA t✓
Block No.
CONST UCTION INFORMATION:
_ _
`�d i a wo�kTo- be`er� rmed under this permit - c�tec a app�Ty
HVAC F1 Gas Tank [3 --as Piping Shutters 13Windows/Doors
Electric EiPlumbing ❑Sprinklers O Generator FIRoof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $� Utilities: 0 Sewer l =J Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Address: (Dgl h � ,i2&R 0a-,
City: State: LI
Zip Code: Fax:
Phone No.—q ()LA 3Q 3 - O1 13
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: 6UVEII LA0,0Ac"i i
Company: Ct.( 37o rvt A % r S �,i , ;
Address: 1 &7,15 S E 1%i t ZtQ-e C T ee Yt l3 r
City: 0� r St v c c State:
Zip Code: 3.+q 52- - Fax: '11U-
Phone No. T11 335`32 -32-
E -Mail:
35 -3 -32-
E -Mail: t?U atcwIf- StiS 4 001 CGvr4
State or County License: Ct ri G C.' 51 8 LIC -1
R value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENIALCONS IRUCIION LIEN LAW INFORMAIION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable ;
Name:
Name:
Address:
Address: I
City: State:
City: State: j
Zip: Phone:
Zip: Phone:
i
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable I
Name:
Name: I
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 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.
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Signature of Owner/ essee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA ,
�2{ C` E' X Z L
COUNTY OF ,C U l COUNTY OF
i
The forgoing instru LeDet was acknowledged before me The forgoing instrument was acknowledged before me
LIby J
this day of ,S 20 this S% day of L>N 20 L7 by
- �UrfiS �igfnmor7E 1'ZTI MM0n S-
(Name of person acknowledging j (Name of person acknowledging)
i
(Signature of Notary Public- State of FI a } (Signature of Notary Public- Stat of Flori
Personally Known ✓_ OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of IdentificationProd1 cped
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Commission No. D CJ qb a& CHRISTINES191mission No. GHk4�TiPdT :, r �.
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* W COMMISSION ie o5260
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* * MY COMMISSION / GG 05M
Rezised07/15/2014 '
I IRES:Apd4,2021
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MY OMM
REVIEWS FRONT ZONING SUPERVISOR i PLANS I VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW I REVIEW REVIEW REVIEW REVIEW
DATE
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COMPLETE
INITIALS
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