HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
j�-� Permit Number:
dunning Vermix APPllcavon
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34582
Phone: (772) 402-1553 Fax: (772) 462-1578
Commercial Residential
PERM I APPLIC:A I ION I -OR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPKOVEMEN I LOCAL ION:
Address:
Legal Description:
Property Tax ID #: ;_ d 7 / -% _ ��� / v `� Lot No._
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
UE I AILED UESCKIP I ION OF WORK:
LII2 C, 'moo! t-1 Kr i�o✓� l`l.Si'<1 C�P�Sc. ,t� � ��Db''
CONSTRUCTION INFORMATION:
AMittona wor to e er orme3 ui�r t—hi s permif z
HVAC Gas Tank []Gas Piping
Electric Plumbing Sprinklers
Total Sq. Ft of Construction:
,jjc O —
Cost of Construction: $ /
appiy:
Shutters Windows/Doors
Generator Roof Roof pitch
Sq. Ft. of First Floor: _
Utilities: 0 Sewer a Septic
OWNER/LESSEE:
Name
Address:�/�`�1A�
City: �� - State:`
Zip Code: �� Fax:
r �
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page { if different
from the Owner listed above)
CONTRACTOR:
Building Height:
Name:
Ci'r<TI r
, Anko'1G(15
Company:
Cu nn rr- Nt
A
Address:
14 t 5 C
L/l l ( tic, -e ,'r ee i1
City: i C: F� T SL - u c; e_ State: r�
Zip Code:
'�L H -g52 -
Fax: 77J- j .35-112i
Phone No.
I'll
3-3:5
E -Mail:
Cu Stair Sti, lc C, c_Gvrti
State or County License:
C� G C.' 51 E
--- ----- ---- ------------
If value of construction is $2500 or more, a RECO
RDEd Notice of Commencement is required.
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SUPPLEM EN I AL GUNS I RUC I ION LIEN LAW I NFORMA I ION:
DESIGNERANGINEER: _ 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: 1
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 pemnit will authorize the permit holder to build the subject structure
Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
which is in conflict with any applicable
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.14
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s
Signature of Owner/lessee/Contractor as Agent for Croner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
�� COUNTY OF �t �� C--/
COUNTY OF ,L t% C` l e --e
The forgoing instrun nt was acknowledged before nie The forgoing instrume twas acknowledged before me
this day ofP-�� 20 thisay of I �� 20 by
- eurb-) �RolMOP 9
(Name of person acknordedging } (Name of person acknowledging)
i
(Signature of Notary Public- State of FI (Signature of Notary Public- Stat of Tiori
v4da)
Known OR Produced Identification
Personally Known ✓ OR Produced Identification Personally
Type of Identification Produced Type of Identification Produced
cHp
/r� r-,r
Commission No_ tIl C7 05� 7 b CHRISI�EB mission No.
* # MYCOMMIS M# 05"
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Re-vised 07/15/2014 a� � EXPIRM.Apir4,2MI
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS I ;
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