HomeMy WebLinkAboutbuilding permit ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: S Permit Number:
4' J
i3milaing rermix Appmaxion
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 t/
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
FERMI I APPLILA I ION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVLMF-N I LUCAI ION:
Address: �J� CQM� �� Me L
Legal Description:
Property Tax ID#: " 001) 5 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DEIAILED DESCKIPIION OF WORK:
�,�►fie` r 1�..:�� 4 7 or, 14 S�e.e c- 10 l�W kAR O:-- .
CONSTRUCTION INFORMATION:
Additional-work o e erfoi•mid—l"unaerr permit=c ec a app`Ty:-- --�`---"--
HVAC L.1 Gas Tank Gas Piping�hutters E]Windows/Doors
Electric Q Plumbing Sprinklers U Generator ❑Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ Utilities:0 Sewer QSeptic Building Height:
OWNER/LESSEE: CONTRACTOR: +
Narri a Qbc` �'e l O�1\e to Name:_ C U(LI T I S ,S o►;m ,\e r1.)r --- 1
Address: 13g Oln nn� n n be% Q,;O Company: &u s-To n1 A , r- S Li S eVK S
City: 1 G i^4L tt W a:a State: r` Address: 14115 V1 i 1 eta-e r ee n, 0 r" j
Zip Code: 3119°5 2 Fax: City: ('0 I T r St L uc t e-
State: r�-
Phone No. rl I - B't$ - 64 3Z Zip Code: a+g52.- Fax: 7`Y�?. J 357-1
E-Mail: Phone No. Tla. 3 3 S - 313 1
Fill in fee simple Title Holder on next page{if different E-Mail: C u S t &i r s ti -P c o(.C(,Vy".
from the Owner listed above) State or County License: G o 519 10
i
if vatue of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SU PPLI_M LN I AL CONS 1 HUC l ION LILN:LAW I NI~URMA t IIIJIN:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
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
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 recWding your Notice of Commencement.
_ s
Signature of Owner) essee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF XY 4 U e J e COUNTY OF LS Z ti 6
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 11' day of_AQ au-,-k. _, 20 V-A_by this_-A_day of 120 12by
- �Ur>`iS 'IgmmoilS & i 5 snWI ► OYA S . _
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Ft a} (Signature of Notary Public-Stat of Flori
Personally Known_✓_OR Produced Identification Personally Known OR Produced Identification_
Type of Identification Produced_ _ Type of Identification Produced
�l Jr y / r '4' CHRI�Yit,p.3' ISH
Commission No. C1 t✓ Ya kE, CHRISTINEB mission No. A t� �. `�+
MYCOMMISSION/3005M
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0111, iald�e Thu 8Wy1 No�ty Enka •'.a. _.-
Revised 07/15/2014 * MY COMMISSION 0005"
04 or EXPIRES:Apra 4,2021
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS i
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