HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:- 1 •I�J�U
Planning and Development services
Building and Code Regulation Division
2300 idrginia Avenue,Fort Pierre A 34982
Phone:(772)462-1553 Fax:(772)462.3378 Commercial Residential
PF-KMi I APPLICA I[ON FOR: To Select from dr-opbox, click arrow at the end of line
PROPOSE0 iMPROVILME V l L'UCAI ION':
Address:
Legal Description:
Property Tax ID#: �5� ,1..7,6 -ad z4--A,90-11 Lot No.
Site Plan Name: Block No,
Project Name:
Setbacks Front Back: Right Side: Left Side.
L)HAiMI) DMS .'RIOJONi LIF WOKK:
/ �IdL �x�r X11*� 3.� .�„ �d�rc� �ArSG Q✓`i, �a/rr✓
CONSTRI� T1�7 . I.N. CJRil11ATI[3�11: _
Additional wor o •e e rm un er is perm —c ec a appy:
HVAC �]GasTsnk as Piping _Shutters 1Nindowsjpoors
i__N
Electric 11 Plumbing Sprinklers []Generator ❑Roof Roof pitch
Total Sq.Ft of Construction: S .Ft.of First Floor:
Cost of Construction:S r �Sf� Utilities Sewer Septic Building Height:
OWNERAESSEE: CONTRACTOR:
NarAe Name; C l! t l S�i6 ru yC r15----- _
Address: - Company: .6 %r &;q5;t evn5 l r:e-
City: /� ✓;"�,['.rP� --.._......-.__-_ Stater- Address: S.E Vr- I reeR 0 r
Zip Code:-__-- 95� Fax: City, St. L,,q c_ C2=
- State:
Phone No. 77; yri [ft =---- Trp Code: 'fgS2- Fax: 77J- d 3 5-l of � g
E-Mail: Phone No, _ " '� . 3 J S -3 2 3 l
FIN in fee simple Title Holder on next page(if different E-Mail:--_-_-- - 14 S t tL I r s a o 1-(el V)%
from the Owner listed above r
1 State or County License: ��(,:�t? 5 l � (19
If value of construction is$2500 or more7a RECORDED Notice of Commencement is required. --"-- � �
3UFPLF.M EN I AL CE)NS I RUC:,]I ON LitN LAVuA NFOKMA I ltJ1V:,:
DESIGNER/ENGINEER: w Not Applicable MORTGAGE COMPANY: �Not Applicable
Nance: Name;
Address: Address,•
City: _-- State: City: _- _ —State:
Zip, __-- Phone: Zip:—Phone: -
FEE SIMPLE TITLE HOLDEN: ,_„•_Nat Appllcable BONDING COMPANY. Not Applicable
Name: Name:
Address: Address:
City: City:
Zip:. Phone: Zip,_ _ ._Phone.•
I cerrifythat no work or installation has commenced prior to thP,issuance of a permit.
St.Lucie County makes no representation that is granting a Permitvrin authorize the ermit holder to build the subject stricture
which is in conflict with any appricable Homeowners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult with your Homeowners Association and review your deed for any restrictions which may apply.
in consideration of the granting of this requested permit,t do hereby agree that 1 will,in all respects,perform the work
in accordance with the approved pians,the Florida Building Codes and St-Lucie County Amendments,
The foliouving building permit applications are exempt from undergoing a full concurrency,review:room additions,
accessory structures,swimming pools,fences,wails,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencernent 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 re c ing your Notice of Commencement.
S
Signature of owner essee/Contractor as Agent for oRvner Signature of Contractor/License Holder
STATE OF FLORIDA, STATE OF FLORIDA,
COUNTY OF ,V,4{l am COUNTY OE_
The forgoing Instrument was acknowledged before F17e The forgoing instrument was acknowledged before me
this d� day ofd _, 7a/',by this�l day of K Zp by
A eUr LIS % nnmmon s r I s sn-mlm�n S..
(Name of person acknowledging) (Name of person acknowledging)
(5ignature of Notary Public-State of FI a) (signature or Notary Public-Stat of Flori
Personally known ✓ OR Produced identification personally Known OR Produced Identification
Type of Identifica/t'io/rn�Produced Type of identification Produced
Commission No.lrt Uf Jr � r 78�lEB 1� Pv*tDRi"?za}r, IBH
mission No_ No, .� :t, • Gtr
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REVIEWS FRONT ; ZONING SUPERVISOR I PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW j REVIEW REVIEW REVIEW REVIEW. REVIEW
DATE l
COMPLETE
INITIALS
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