HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /- 1 f - 1 � Permit Number:
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outiaing rermix App icavon
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
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PEW I APPLICA I ION FUR: To Select from dropbox, click arrow at the end of line
PROPOSED I_MPKOV_EMENN I LOC_AI ION:
Address: 70,g ,3Q-r- %ia Abd r A P-1
Legal Description:
Property Tax ID #: 3 -00 S yy Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DE I AILED DE5C:KIN I ION OF WOKK: 1
3°IVSec( A)
CONSTRUCTION INFORMATION: __.
rme un er �s permit
ona wor - c ec a app
TO e Pe
HVAC []Gas Piping aWindows%Doors
Gas Tank —Shutters
OElectric Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
r
Cost of Construction: $ 1l` 0 S�` Utilities: Sewer Septic Building Height:
..OWNER/LESSEE: _
CONTRACTOR:
Name �f'��� 2 d Name: G('1rCi(S ,SA44,4,v\CnS
Address: r r2� Company: Cu i-ro rvt A u S t eyYlS
City: 1:7-c)r-4 i�� 2 rCe State: �L Address: 14-) t 5 S
Zip Code: 3CPC5 Fax: City: PO PLT 9t. L (,,c,(f--- State: te-
Phone No. 245 - g a - 0131 Zip Code: a+452. - Fax: 77a- .j 3 55-19
Phone
E-Mail: Phone No.
Fill in fee simple Title Holder on next page ( if different E-Mail: C u S t ct r s y s �; Cc 1 C c. rn
from the Owner listed above) State or County License: ,q co
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tf value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEM EN I AL CONS I RUC I ION LIEN LAW 1 NFORMA 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: 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
is in with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or such
which conflict prohibit
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, 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.
Signature of Owner/ essee/Contractor as Agent f or Owner Signature of Contrac or/License Halder
STATE OF FLORIDA (, . STATE OF FLORIDA r>
C` E COUNTY OF tie
COUNTY OF V ,C C% l /-e.
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 9 day of a -hurt . 20 b� this `% day of j Cc� 20 by
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mmor? C�icril S unMMon S
(Name of person acknowledging } (Name of person acknowledging)
(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. if l 5,� `t rc a°i cE SNE B mission No. C-1 `7 t/ ✓ �f �' '`� t
* * MYCOMMISSIM G052515
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� IXPIRES: .2021 l
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err` * * MY COMMISSION GG 05M
Revised 07/15i2014
� EXPIRES: npd4,20Yt
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW i REVIEW REVIEW REVIEW
DATE
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COMPLETE
INITIALS
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