HomeMy WebLinkAboutpermit applicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: f� �I Permit Number:
tsuimilrlg rerl' a Appilcaiion
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 Residential
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PEKMI I APPLICA I ION FUR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPRUVI=MENI LUCAIION:
Address:
Legal Description:
Property Tax ID #:
NU_ (� �,S p�/ Lot No.
Block No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
DEIAILED DESCKIPIION OF WO KK:
CONSTRUCTION INFORMATION:
-Ad_d-fflona wornto be perormed under this permit = cl
HVAC 0 Gas Tank ❑Gas Piping
11 Electric ED Plumbing 11 Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ _
OWNER/LESSEE:
3 foo
tnal appiy:
Shutters a Windows/Doors
11 Generator Roof Roof pitch
Sq. Ft. of First Floor:
Utilities: 0Sewer oSeptic Building Height:
Name ql i�af% Pam oma' Y.rnrn"
Address: A� Ce 11'
City: CYJq'J_eM Com+ State:
Zip Code: I l53 0 Fax:
Phone No. 51h "fl - ��
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name: G i,' ec 'S it-) a. C s1Cccn l C 7C AI � J S� eVl1 � l r
Company:
Address: l �t° (5 � i✓ �t i LGiC -r � C>?e i1
City:
ti" R - 9t . L c; e_ State:
'PLT-
Zip Code: `fq5 Fax:
Phone No. 7 J 3:5-
E -Mail: C u S t C"
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SUPPLI_M EN I AL CONS I RUC I ION LIEN LAW I NF ULAMA I [ON:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
State:
Address:
City: State:
City:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
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 Countymakes no representation that is granting a permit will authorize the permit holder to build the subject structure
is in with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
which conflict
structure. Please consult with your Nome 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 recofding your Notice of Commencement.
s
Signature of Owner/ essee/Contractor as Agent for Owner Signature of Contra r/license Holder
STATE OF FLORIDA // STATE OF FLORIDA
XY,t,UC`l COUNTY OF
COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this / day of ✓-- d S 20 7by this a l day of d/'US 20 17 by
- eurfIS fnmorlE eu 12TI S snMM0rA S
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public- State of Fl a) (Signature of Notary Public- Stat of Flori
_
/
Personally Known OR Produced Identification
Personally Known ✓ OR Produced Identification y
Type of Identification Produced
Type of identification Produced _
Y"°�� i
Commission No. U1 Ul V 5 ,� �b cHmnNEB mission No. foy' —
MY COMMISSION i X 05M rr ��
*
EXPIRES: April, .2021
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_aona.e n.0 Hanrlr s.rvie«
horn * * MYCOMMISSIMI#GfiORM
Revised 07/15/2014 �o� pMAI:0114.21211
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REVIEWS FRONT ZONING SUPERVISOR ' PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW I REVIEW REVIEW REVIEW REVIEW
DATE
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COMPLETE
i
INITIALS 1
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