HomeMy WebLinkAboutBUILDING PERMIT ALL APPLICABLE INFO MUSTBE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
u1:12-
nuitaing vermn Appiicavon
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 (l F
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PEKMI I APPLIC;A I ION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMEN I L_U_CAI ION:
Address: �� �(y
Legal Description:
Property Tax ID#: 'N F_5 " rl c)S— y0 yb_ 0 DO Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DE I AILED UESC:KIP i ION OF WOKK:
r SC-
CONSTRUCTION INFORMATION:
a wor o e er rmee under is permit—c ec a apply:
Gas Tank ❑Gas Piping _Shutters Windows/Doors
g`H�
OElectric Q Plumbing ❑Sprinklers Q Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ �� Utilities: Sewer nSeptic Building Height:
OWNER/LESSEE: CONTRACTOR:
i
Name Name'. C U 1i T P"I0 Q 5. --
Add re s: 1 mpany: Cu5-ro M A , r s�.i s eWt; n c,
City: C'� C. l7G 1 State- ( Address: 14,[5 S E 17 aG-e �r ee R
Zip Code: o Fax: tj
City: P�2T St �- c �- State:
Phone No. �0� 2(O�^ (D aO� Zip Code: a+q 5) Fax: '77J. d 3 5--i 5 <<
E-Mail: Phone No. 7 q), 3 3 5 - 313 1 j
Fill in fee simple Title Holder on next page(If different E-Mail: C u a t n-i r s y s .E a a •c t.vrt
State or County
from the Owner listed above) License: G O 5( � l 1
i
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMEN IAL CONS I RUC ION LIEN LAW INFORMAI ION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name:_ V�v 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 l 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.
_ s
Signature of Owner/ essee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA / STATE OF FLORIDA UG/� --
I
COUNTY OF �� U C/ e COUNTY OF
The forgoing instrument was acknowledged i
The for oing instrument was acknowledged before me g g ged before me
this day of_ 20 11 by this day of PIXLLJ 20 by
i
• eurbs ',gm Mon 9
(Name of person acknowledging) (Name of person acknowledging)
of Notary Public-State of Fl a Si ature of Notary Public-Stat oe� f Fiorl
(Signature Y } l � rY I
Personally Known L-�_OR Produced Identification Personally Known OR Produced Identification_
Type of Identification Produced— _ Type of Identification Produced_ ��f►
�t1 GT (� d1' CHRI$Tih"l ISH
Commission No. : CHRISTiNEB emission No.
MY COMMISSION 1f 3GO525116 ` M
EXPIRES:ApdI o,2021 rr N+ t> 3«vlca
Bonded Thru Budget Notary Servksa t ......% CAB Qtt t
Revised 07/15/2014 * * MY COMMISSION 0 GG 052M
P\o� EXPIRES:April 4,2021
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS