HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ✓ do Permit Number:
ouillairig Nermii Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-2553 Fax: (772) 462-1578 Commercial Residential
PEKMI I APPLICA I ION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED I_MI'_KOVEMEN I LOCAI ION:
Address:
Legal Description:
Property Tax ID #: Jy' 5��-1���� �!/� Lot No.
Block No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
I
UE I AILED UESCRIP I ION Oi- WOKK:
//Se_ 1"--r L
CONSTRUCTION INFORMATION:
Addition---VT worr e er rme- un er t is permit = cT► -6k a appy:
HVAC
Gas Tank ❑Gas Piping Shutters Q Windows/Doors
Electric Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ �.��� Utilities: [] Sewer _ Septic Building Height:
OWNERAESSEE:
Narhe F'11rICer�L ' —
Address: �t���s f �/1�- T'�' ���
City: �a' St State: F%
�
Zip Code: J41e6 Fax:
Phone No. 17fl., ZZ -,Z-1
E-Mail:—
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name:
Gu LTI < �t�rru'\C(I
Com pany:
C u S Tc rK A r c; S ev►1; (n r�
Address:(li
15 /l l dG �� ee'e i1 �� l
City: Po R -t 9t Luc; _ State: ��—
Zip Code:
4Fax: '77J j 3.S -i
Phone No.
7 '� 3.3 5 - 3 )- 3
E -Mail:
C S t ci I r 5 y; Cc t C G Esti
State or County License: C C' 5 I E 10
it vatue of construction is $2500 or more, a RECORDED Notice of Commencement is required,
SUPPLEM EN I AL CONS I RUC l ION LIEN LAW I NFORMA I ION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
3
Zip: Phone:
Zip: Phone:
i
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable '
Name:
Name:
Address:
Address:
City:
Cit I
Y: ,
Zip: Phone: j
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 exempt from 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 recording your Notice of Commencement.
vv s
Signature of Owner/ essee/Contractor as Agent for (Xvner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
E COUNTY OF
COUNTY OF >�2t a C` l e
i
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this ,n; h day of 20 jLb.� this �� day of �i�J 20 by
a �
-turns ��fitwtc�nS C�urTl S S m4�c�n S
(Name of person acknowledging) (Name of person acknowledging)
Z i
(Signature of Notary Public- State of Fi a j (Signature of Notary Public- Stat of Flori
s
/ /
Y
Personally Known ✓ OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification
/,fProduced [� /
Y P V! Orf 0 � IX S In �Y •� CHklcgu,c
Commission No. C7 OU � q6 �a. CHWT1NEB mission No. �Ni ? •'
* * tevcow MISSloN � 052546
y E>D'IRES_Apri .2ort --t�;,�,.. `BEH-—_•
man. B�aTM�e�►�r
Revised 07/15i2014 * * myc sssloNmoom
°� `oma EVIRES: AM 4, 2021
I
REVIEWS FRONT ZONING SUPERVISOR ' PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW € REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
!
INITIALS I