HomeMy WebLinkAboutpermit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
j Permit Number:
Date: �V
•
nutilaing Vermix Applicavon
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 Residential
Phone: (772) 452-1553 Fax: (772) 462-1578 Commercial
PEKMI I APPLICA i ION FOR: To Select from dropbox, click arrow at the end of line
PKUPUSEU IMPKUVEMEN I LUCAIION:
Address:
Legal Description:
Lot No.
Property Tax ID #: .��� 7� ' �°Z 3 -? •
Block No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
UE I AILEU UESCKIP I ION OF WOKK:
X11
.,t /y,I Vl )t {" ' n" f qs"r dt rlse,
CONSTRUCTION INFORMATION:
Adui-on-a7w-,-oor o e e rme under
HVAC 11 Gas Tank
11 Electric ElPlumbing
Total Sq. Ft of Construction:
Cost of Construction: $ `3'3 )� 0
OWNER/LESSEE:
this permit d -all apply:
_Shutters aWindows/Doors
[]Gas Piping
❑Sprinklers
Generator F]Roof Roof pitch
Sq. Ft. of First Floor: _
Utilities: 0— Sewer 0 Septic
Address
!a. �' NJ
City: _, `� State:
Zip Code: 0 7ya 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:
Cu1LTl ,SNrLl6tilc0S
Company:
�u37arvt /� �r S�s�ey�S lti�,
Address:
`/ l�
C U l I �� �� C>?e i1
J �
�� �T St Luc it-, State: f
City:
Zip Code:
Q52- Fax: 7`7? j3�"iSIC<
Phone No.
T11 3 S 3 3
E -Mail:
u g t C' i t S Cc o C G vrt
C° G O 5 i 'F ( C)
State or County
License:
if value of construction is $2500 or more, a RECORDED Notice of commencement is required•
i
SUPPLEM EN I ALC ONS I RUC I ION LIEN LAW INFUKMA I ION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone:
Zip: Phone:
i
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name: j
Address:
Address:
City:
City:
zp: 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
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 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 recofding your Notice of Commencement.
i
Signature of Contrac r/License Holder
Signature of Owner/ essee/Contractor as Agent for Owner
STATE OF FLORIDA/
Xt
STATE OF FLORIDA
COUNTY OF �t L uG-/-Q
COUNTY OF d UCrl e
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
-76y
this day of 20 Ibv
this day of 20
- eur1<l; ���fnmoY1S
ea r2T1 S JAmmon S.
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary Public- State of Fl a)
(Signature of Notary Public- Stat of Flori
Known OR Produced Identification
Personally Known ✓ OR Produced Identification
Personally
Type of Identification Produced
Type of Identification Produced
Commission No. U l [7 5, `t b CHRISTINE g
mission No.
:a
* t MY COMMISSION!
3005M
swk s +
Fly 9a1AeeT1Vu
MY�
" *
Revised 07/1/2014
�� EXPIRES:AW14=1
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REVIEWS FRONT ZONING SUPERVISOR '
PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
1
COMPLETE
INITIALS