HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /0 - C3 - i �7.
Permit Number:
•
ouliming rermix Appiicavon
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 402-1553 Fax: (772) 462-1578 Commercial Residential
PEKMI I APPLICA I IUN FUR: To Select from dropbox, click arrow at the end of line
1'HUI'USEU IMF'KUVEMEN I LOCA11ON:
D
Address: 6t L 17 i l E
Legal Description:
Property Tax ID #: �3� %` s�oZ __ Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
DIE IAILED UESC:KINIIUN Of- WOKK:
(✓ ` �e '1 a ✓/ L�7`C_ `�'�7'�- /!.l J"�° j C /)i�1�ASL �;j�� �/1, t.✓
CONSTRUCTION INFORMATION:
-n��+-��nai �Nn��-tn—Fie oe�-me�c un er t is permit -
17771
HVAC LJ Gas Tank LJGas Piping
11 Electric ElPlumbing Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 3
76
OWNER/LESSEE:
Na m
Block No.
appiy:
_Shutters aWindows/Doors
11 Generator F]Roof
Sq. Ft. of First Floor: —
Utilities: FSewerE1Septic
Address: l CQQ �ti Q'
City: State: hl f7
Zip Code: 0/ 9 041 Fax:
Phone No. 7Al- 95i-7i8q
E -Mail 1lt-13 CVic uon, ocl
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Building Height:
Roof pitch
Name: L'C-fI ,S i;ryo'\cnS
Company: Cut 5 -To (Pt A % c ; e121.,
(n;
Address: %[ 5 t �/' I i dG �I C ee ii
City: tat% P -T 9t . 1_ a c; _ State: r�–
ZipCode: 4+qS'2- Fax 7r(7. 3.5-i
Phone No. '� 1 3 3:5
3
E -Mail: Cg stctilr Sti, CX C, r t.wti
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
ISH
062545
SUPPLEM EN 1 AL CONS 1 RUC i ION LIEN LAW INFORMA 1 ION:
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
bylaws covenants that may restrict or such
which is in conflict with any applicable Home Owners Association rules, or and prohibit
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
s
Signature of Owner/ essee/Contractor as Agent for Owner Signature of Contra cto r/License Holder I
STATE OF FLORIDA STATE OF FLORIDA/
St 4 OF
COUNTY OF u e 1 �' COUNTY
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of To 13 F e- 201 7 by this day of t '-1 l n r 20 /1, by
- eurf1S nmmoY}S" (turZTI 5 �nmmoYA S
(Name of person acknowledging } (Name of person acknowledging)
i
(Signature of Notary Pu/blic-State of FI a } (Signature of Notary Public- Stat of Flori
OR Produced Identification
Personally Known ✓ OR Produced Identification Personally Known
Type of Identification Produced Type of Identification Produced j
�� ir�c ' ° l
Commission No. lJ1 enc Yb CIIR{St9B mission No_ O ✓ �S`1 �'
*
* * MycoMAwuS "t 052515 _•.
I EGWJMApa .20Z, .,A. i
- _ _
MYORM
* *COMMISM_GG
Revised 07/17/2014 e :/lptl � 2021
t
REVIEWS
FRONT ZONING SUPERVISOR PLANS ; VEGETATION
SEA TURTLE
MANGROVE
COUNTER REVIEW REVIEW + REVIEW REVIEW
REVIEW
REVIEW
DATE
i
COMPLETE
i
INITIALS i
i
ISH
062545