HomeMy WebLinkAboutbuilding permit ALL APPLICABLE INFrO7 MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I -�0 / _ Permit Number:
nuiiaing rermit Application
Planning and Development Services
Building and Code Regulation Division
2-300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
NERMI I APPLICA I ION FOR: To Select from dropbox, click arrow at the end of line
PHOPUSEU IMPROVtMEN I LOCA I ION:_ ( /� _.
Address: ---- [�C C - CC i g'L4 rJ _....0r--eek R��—_-�^Lt.�11' (LL4 J `7,I 9 ! y
Legal Description: 1
Property Tax ID#: `f a�3 ! l -�DD D DD Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DEIAILEU UESCKIPIION OF WOKK:
•S 'rn^ 1SSre1 Ilex /Poov►IP
CONSTRUCTION INFORMATION:
Additonalwor o e er rme un er t is perFnTt___check all thgd apply:
SHVAC Gas Tank []Gas Piping _Shutters Q Windows/Doors
11 Electric Plumbing Sprinklers Q Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 7�I00 ,ao Utilities:0SeweraSeptic Building Height:
OWNER/LESSEE: CONTRACTOR: Y
Name_ rf�iri�( d uJctrr� inP Y� Sctr Name:
Ci'Ve fSNnikslc0S
Address: 1 a-C O ni v�( Win e rs Cree k RJ Company: 77e,rvt
City: 0,1 m e'tu State:FL Address: 14')1$ 'S E V; I] au-.e t�r ee ilk
Zip Code: � 144 C' Fax: City: FO2T Sr. ,Luciet- State:
Phone No. 33 6 - 110 9 Zip Code: `FgS2 - Fax
E-Mail: Phone No. I q�L 3 3 S - 3 I
Fill in fee simple Title Holder on next page(If different E-Mail: u 3 t n-i r S y Cc o l C[,rm
from the Owner listed above) State or County License:
__J
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLi_MtNIALCONSI RUC IION LIEN LAW INFURMAIION:
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: i
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
WARN ING 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.
s
Signature of Owner) essee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA / STATE OF FLORIDA
COUNTY OF X-e COUNTY OF
i
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this /,? day of f g9 t 20/ by this /?day of 't 20 L by
i
eU r hs rZ*rI 5 �Y•}M Mori 5
Name of person acknovAed ing (Name of person acknowledging)�1? )��04Z �,Oe_,Z�
(Signature of Notary Public-State of FI a) (Signature of Notary Public-State/of Flori
Personally Known ✓ OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced /,/ Type of identification
,oProduuce�id �//
U1(17 Q S�� 7 b A 4 0�/ c[5`1 tt^ cHktSr: :, , 452
Commission No. CtiRtsT�9 mission No. * '� �w;�,. . • ,,�.,;t 05�
*IVA* MYCOMMgSS1 O 3GOSM )21
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE !
COMPLETE
INITIALS