HomeMy WebLinkAboutpermit applicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ! C -%� `� / Permit Number:
nuiming vermin Applicavon
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PEKMI I APPLICA I ION FOR: To Select from dropbox, click arrow at the end of line 1
PROPOSED IMPRO_V_EMENN I L_UC_AI ION:
Address'-- ---- �/� X44 ..-ll/Z^_
Legal Description:
Property Tax ID P: �7 7 ' /n� -p�c5 % - Lot No._
Site Plan Name: Block No.
Project Name:
Setbacks Front
Back: Right Side: Left Side:
UEIAlLED UESCRIPIION OF WORK:
��k` �sflr LIKE .3�°•^ !`/Sty' C��ns�. �..i ��/�w
CONSTRUCTION INFORMATION:
A-dditiona wor o e er orme- un er t is permit =
LLIJHVAC Gas T ank Gas Piping
11 Electric Plumbing 11 Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ _� / �
OWNER/LESSEE:
tm appiy:
_Shutters aWindows/Doors
ElGenerator F]Roof Roof pitch
Sq. Ft. of First Floor: _
Utilities: OSewerF—]Septic
Name C&6AW 1,5 _K ui L
Address: -
City: PJB `tState: F/
Zip Code: V'�J5,;21 Fax:
Phone No. (c0 � - q, 4 - C, 752-
E -Mail: -
Rif in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Building Height:
Name: Ci' CT (r ,S►arLtyv\c n
Company: Cu 57c m A r �-1 S t em (n r:
Address: 1471,5 S E �/l I (dG -.,_ C r ee r,
city: t P --r St , E u c(e_ State: �L
Zip Code: `F452 Fax: 17 it,) .35-�
Phone No. •� .-1 a 37 3 S
E -Mail: Cu.Stc_If- Sti, Cf, c614Y2
State or County License:
if value of construction is $250o or more, a RECORDED Notice of Commencement is required.
i
SUPPLEMEN I AL CONS I RUC ION LIEN LAW INFORMA I 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: j
Address:
Address: I
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 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.
i
s
Signature of Owner/ essee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
Xt COUNTY OF
COUNTY OF U r?l -e.
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this lob day of OC r20 +? b this I d day of Cc T 20 1 7 by
- eu r LI S �tq on Mon S. &U INTI 5 OM Mo rA .5.
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public- State of FI 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.U1 J 7 b CFiRtSiWE6 mission No. U? UI ✓ a S`1 * �N -
MYCOMMISSIONi 052516 *
•�'
DO'IRES ApI .2021gT
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Revised 07/15/2014 ',r. `oe EXPIRES: Apr14,20'2M111
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REVIEWS FRONT ZONING SUPERVISOR ' PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW ! REVIEW REVIEW REVIEW REVIEW
DATE
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COMPLETE
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INITIALS