HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: _ _20_ (' Permit Number:
s
nuiiaing rermil Application
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
YEKMI I APPLICA I ION I -OR: To Select from dropbox, click arrow at the end of line
I'RUPOSED IMYKUVEML_N I LOC.Ai IUNI___.______--
Address: ' -4�:; g
Legal Description:
ProDerty Tax ID #: 3 LAo@ (c t)q - C*) 317(a — U 00 - ti Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
DE I AILED DESC:RIP I ION Ut- WORK:
Gape— /=,r Lli(e 2T`0.rt
CONSTRUCTION INFORMATION:
HVAC L__J Gas Tank L_�Gas Piping LJ Shutters
11 Electric 11 Plumbing ❑Sprinklers Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor: _
Cost of Construction: $ 3 �� Utilities: Q Sewer 0 Septic
OWNER/LESSEE:
Narrie X ��
City: (' ' r'
State: EL
Zip Code: 3 Fax:
Phone No. nr1a - 2 4 ""
E -Mail:
FII in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Block No.
QW indoors/Doors
❑ Roof Roof pitch
Building Height:
Name: GilacZir �-)A4 6NCC#g',
Y�
P
Cam an (u 37o m A r U S tt em S i1 _
Address: 1 !c' (5 S E Vi I dG � ee k �� r
City: fro R -r 9t . L v co e State:
Zip Code: a Fax: 717J-
Phone No. i '� 3 3:5- - 3 13 ')-
E -Mail:
E -Mail: Ck stair Sys Gcc,i Cc�n
State or County License: C� C' 51 F r
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENIALCONS IRUC IION LIEN LAW INFORMAIION: j
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
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
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 your Notice of Commencement.
�✓ t. s
Signature of Owner/ essee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA�r STATE OF FLORIDA
/—UCP/ COUNTY OF_t G ULf
COUNTY OF t� Zc E E'
The forgoing instrument was acknowledged before rile The forgoing instrument was acknowledged before me
this Tib day of K_LtMe bbIpg r , 20 LI by this ZO day of JKJ0..JLy,MIa!L r , 20 _LJ_ by
• euri`_IS Rfnmor? S" (7 T-1 S S�r�iVl bv1C%
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public- State of F1 a j (Signature of Notary Public- Stat of Flori
I
Personally Known OR Produced Identification Personally Known 1/ OR Produced Identification
Type of Identification Produced Type of Identification Produced
/ I / Ptl�
��� ^'n* p`"�'-:?
Commission No. CHRISTINE B emission No. Vi `7 .; c�✓�1 �%
*�
MYCOMMISSION# G05M !
* * �1
V ! EXPIRES:Apr1 x2021 r '
--- ---- --- -- - — -- - i -�HRh§. 9R BEN
-- -- awvm I M Budget N y sxNoes td�;�
Wop
fl' * * W COMMISSION * GG 052b/6
Revised 07/15/201
`oma EXPIRES:Ap44,2021
I
REVIEWS FRONT ZONING 1 SUPERVISOR I PLANS ! VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW I REVIEW E REVIEW REVIEW REVIEW REVIEW
DATE
!
COMPLETE
I I
INITIALS I
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