HomeMy WebLinkAbout9111 Short Chip appALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 [�A
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION: n
Address: q � I i 1r1 r -� L -\ L' +r
Legal Description: a
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Property Tax [D#: ~V i -- d 1+-] Lot No. q
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Bight Side: Left Side:
! DETAILED DESCRIPTION OF WORK:
�" a, Ott
CONSTRUCTION INFORMATION:
Additional w5FR toe er orme Ander this permit - check a apply:
HVAC - Gas Tank []Gas Piping Shutters Q Windows/Doors
11 Electric ® Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $ _ Q
SFt. of First Floor: _
UtilitiestSewer D Septic
Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name i mt
Name:
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Address: L . ►[�C-�r�_'i47 i (
Company:
Address:
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City: -� i L�_,o1(Q State: f7
Zip Code: 1-0 Fax:
Phone No. n - oZ - C)'QJ (`
Cityg-2
Zip Code:
Phone No.
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E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
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E -Mail:
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State or County License:1
ID
11 value o7 consiruction is 4,r5uu or more, a RMURDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DES IGNER%ENGINEER: __ Not Applicable
Name:
Address:
City:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City;
Zip: Phone:
State
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
— Not Applicable I BONDING COMPANY:
Name: _
Address:
City:_
Zip:
Phone:
Not Applicable
State:
Not Applicable
I certify that no work or installation has commenced prior to the issuance of a permit.
St_ Lucie Countyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in contlict with any applicable Horne 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 ail 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 recording our Notice of Commencement.
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Signature of Owner/. .see Contractor as A ent for Owner
g - .mature of Contra ctor/1_irpnSF�i4nI"ricer
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ', ,.� ; ` ,` COUNTY OF
COUNTY
The forgoing instrument was acknowledged before me
this lz day of 012 r 2p aby
(Name of person acknowledging) "
{Signature -6f Notary Pubii'c- StateWof Florida J �`
Personally Known PrM80I*ifk4&Z
Type of Identificati ff Commission # GG 97150
QaV, "y mmission Wres
Commission No. '�aM1Aprl 24 2021
Revised 07/1512014
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
COMPLETE
INITIALS
The forgoing instrument was acknowledged before me
this liqday of � K _*-6\C?r 20� by
(Name of person acknowledging J
(Signature of Notary Public- State of Fiorida ]
Personally KnownPr - , *"';• J�
g3Rip9Let>%IifiEdf4i#i1=Z
Type of Identificati °o `€J Commission # GG 97150
My Commission xpire
.�'•;•�+Aprll 021
Commission No. �/�„ „���
SUPERVISORPLANS VEGETATION SEATURTLE I MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW