HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a - Ia _ k � Permit Number:
•
auilialing vermix Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 452-1553 Fax: (772) 462-1578 Commercial Residential
PERM I APPLIC:A I ION FOR: To Select from dropbox, click arrow at the end of line
PHOPOSED IMPKOVEMENN 1 LOCAL ION:
Address: �
Legal Description:
Property Tax ID #: 3Lkaa - 50c> " C'3191 - CM _ -1 Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back:
J, -:o1 Q- dor L, pie
CONSTRUCTION INFORMATION:
Block No.
Right Side: Left Side:
14eat-
- cnecK a
HVAC Gas Tank UGas Piping 1_1 Shutters
Electric Q Plumbing F]Sprinklers EJ Generator
Total Sq. Ft of Construction:
Cost of Construction: $ 3 LA\C)
_
OWNER/LESSEE:
Sq. Ft. of First Floor: _
Utilities: 0 Sewer a Septic
Naris e I` t a ► k CA-X1KUW-1 ► V.. V.• v
Address: ISL10 h.0-25 E :7Q -
City: ('► n e : no 0.t% State:
Zip Code: y5 x.55 Fax:
Phone No. L004 r18Z-- ZCQ► �¢
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
QWindows/Doors
F]Roof Roof pitch
Building Height
Name: VC -1 i•slCr2
Com pany: C' u 5 -ro m A
Address: 1445 �Z
city: Po P -r St . L. � State: r�
Zip Code: a+q 52. Fax
Phone No.
E -Mail: CLL tCX. C, CGhL
State or County License: _ A C. C" S 1
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if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SUNNLEMEN IAL ALCONS I RUC:I ION LIEN LAW INFOKMA I ION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
_
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: — Not Applicable
Name:
BONDING COMPANY: Not Applicable l
_ j
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
i
I certify that no work or installation has commenced prior to the issuance of a permit..
which is in conflict with any applicableiHome O rrgers Association rules,by authorize
or and permit holder
that build
ojrprohibit 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 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
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 re c ding your Notice of Commencement.
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Signature of Owner/lessee/Contractor as Agent for Owner
s
Signature of Contractor/License Holder
STATE OF FLORIDA (, /
COUNTY OF Vit �(. C: C` j E
STATE OF FLORIDA .
COUNTY OF t L
y e 7
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 17- day of 1pLX ems{ 20 1S by
this 12- day of ��,�p�o.e T, 20 1 g by
C'
�i'�I� �t4InI'llcyr7S,
v
e,C�T1 J SnmfMGn 5
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary Public- State of FI a)
(Signature of Notary Public- Stat of Flori
t
Personally Known OR Produced Identification
f
Personalty Known OR Produced Identification I
Type of Identification Produced
Type of Identification Produced I
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Commission No. (T!C7 (�5�� 71✓ :" CHRIS71NE8
P J� ox' CHR15'+t."' > r ISI
lmission No. i (4 ''
* * MY COMMISSION X
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Fru ft1M Thu Budget NcWq
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Revised 07/15/2014
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�, `o. O PIRES:ApM4,2ost
REVIEWS
FRONT ZONING SUPERVISOR
PLANS VEGETATION
SEA TURTLE
MANGROVE
COUNTER REVIEW REVIEW
REVIEW REVIEW
REVIEW
REVIEW
DATE
i
COMPLETE
I
INITIALS
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