HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �� Permit Number:
i
nuiming rermn Application
Planning and Development Services
Building and Code Regulation Division /
2300 Virginia Avenue, Fort Pierce FL 34982 (J/
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERM I APPLICA I ION FOR: To Select from dropbox, click arrow at the end of line
I'RON05EL)IMPROVEMEN I L_OCAI ION:
Address; ?fig1 - /i"'XJ { Z71, 7.___ -
Legal Description:
Property Tax ID #: ��� �i�%t7� � � 1 Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
L)E I AILEL) L)ESCRIP I ION OF WORK:
Block No.
CONSTRUCTION INFORMATION:
Addiii onal—worTc tote e—rTorme_d. un3erThTi permif_- c ec a apply: -- - —
HVAC F] Gas Tank []Gas Piping _ Shutters 0 Windows/Doors
11 Electric 0 Plumbing 0 Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 4132-7 Utilities: Sewer Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name /� 2xiQ Q M*4JA2e -I
Address:
Address: &iJ F,&We /&,CW AU -
City: P", f S -z' Gc e State:
Zip Code: AY'2 Fax:
Phone No. �& 7
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:
' uCtilyv,
TI �r1lcn "
Com pang:
_Lo -ro rit A % - 5 ca 5 t e0US ( r' c�
Address:
14:1 S S E etG -� C r ee i^� �� r
City: t G fZT St . uci e State- �L-
Zip Code:
Fax: 77,?-
Phone No.
1 3.3:5- - 3 13 )L
E -Mail:
Ci{ Stc•_Ir Sys 4:�. 0, C, 6.4n
State or County License: C 0 51 5r 10
tf value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEM EN I AL CONS I RUC I ION LIEN LAW I NF-ORMA 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:
F
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 pians, 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, signc-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
COUNTY OF f c�
COUNTY OF � (F I E
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this / day of Al&zA- 20 /7b
this day of 20 _ by
�u r 61 S i III Ii c'O 'S
�u rl- 7_1 5 S m a'hG n S
(Name of person acknowledging j
(Name of person acknowledging)
Z71�11z�_"Mel
'
(Signature of Notary Public- State of FI a)
(Signature of Notary Public- Stat of Flori
Personally Known ✓ OR Produced Identification
Personally Known OR Produced Identification
Type of identification Produced
Type of Identification Produced
Commission No. lT1 C7 Q 5,>?� `f r✓ 1f"P�CHRISTINEB
VIP 7VL'14
mission No. V`t �/ Ly d J'1 L' ••• �N;-:?.. c I
:
: * MYCOMMISSIONf
* i
052543 0l
s
yr EXPIRES Apra
.2021 Yr '�
$$�
WnM Thu Budget No"
S"M t •�,
* �n'cWMIs GORM
fc2W
Revised 07/15/2014
°� :Ap
ExPIREs:Apd 4, 2021
`oma
REVIEWS FRONT ZONING SUPERVISOR
PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW I
REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
i
INITIALS