HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: '2 Permit Number:
�6-��
auilialing vermix Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 Residential
Phone: (772) 452-1553 Fax- (772) 462-1578 Commercial
PERM I APPLIC:A I ION FOR: To Select from dropbox, click arrow at the end of line
pROPOSEL) IMPKOVEMEN I LOC:AI ION:__--
Address:
Legal Description:
Property Tax ID 4:
Bs Lot No.
aa -���-nand -
Block No.
Site Plan Name:
Project Name:
Back: Right Side: Left Side:
Setbacks Front
L)E I AILLV L)LSCKiP I ION OF WORK:
/•s` on /s3er
c
CONSTRUCTION INFORMATION:
e rmeundertnis permit-c"C`
YHVACGasTank 13 --as Piping Shutters
OElectric Plumbing FISprinklers 11 Generator
Total Sq. Ft of Construction:
Sq. Ft. of First Floor: _
Cost of Construction: $ Utilities: 0 Sewer a Septic
Name t f LIMILLI
Address: 7a S c1 R a e tare C'2pt-k L4-�
City: c i e State: f
Zip Code: ��986 Fax:
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
aWindows/Doors
11 Roof Roof pitch
Building Height
Name: CTIS .SA 44,E-Ac(15
u s -To rpt >`� S u stems l
Company:
Address: 1 �C'! 5 ��i I LiG z �� r ee -%
pi
City: POP --r State: r�-
Zp Code: 3+452 Fax: 7rQ- .j 3 L 9 c
Phone No. 112- 2- 3 3:5 - 3 2 3 2
E -Mail: C u S t Ct i r s Cc o f C c. vrL
State or County License: _� G C' J (�
DED Notice of Commencement is required.
if value of construction is $250o or more, a RECOR
SUPPLEM EN I AL CONS I RUC I IUN LIEN LAW I NFORMA 1 IUN:
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: i
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
is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
which
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, %+!alls, 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.
v" 1 5
Signature of Owner/ essee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF%U
COUNTY OF
The forgoThe forgoing instrument was acknowledged before me
ing instrument was acknowledged before me
1 %2J 20 / by
this 6 day of F-eb 20 b�' thisday of
eu r o; of morl S' c �tiTl S Jr trl enc, n S
(Name of person acknotivfedging ) (Name of person acknowledging)
y
(Signature of Notary Public- State of FI a } (Signature of Notary Public- Statof Flori
Personally Known OR Produced Identification
Personally Known ✓ OR Produced Identification
Type of Identification Produced
Type of Identification Produced
00
Commission No. G 0:U `76 CHRISMNE8 mission No. Ul �� 5a �`1 �'
.4144%:C,
* * MYCOtdMISSION6 3G052646
EXPIRES:Apra .2021 �r►u._�.. -r_-
--- i BorkedTiruB�dpetNah7 ---- td�••••� u,Ru�mrBENC�---;
Or M1 ** MYCOMMISSION S GCs ORM
Revised 07/15/2014 a����� EXPIRES:AprU,2021
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
;
INITIALS i