HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 3- % --t 9 Permit Number:
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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
YEKMI I APPLICA I ION FOR: To Select from dropbox, click arrow at the end of line
PHONOSEU IMPKOVF-MEN 1 LUCAI ION:
Address: -
Legal Description:
Property Tax ID #: WJ Zoo — ()(01 7 - o oo-3 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
UE I AILEV DES!': HIP I ION OF WORK:
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CONSTRUCTION. INFORMATION:.
HVa worko e rme under is permit - c ec e apply: (�
❑Gas Shutters Windows%Doors
AC GasTank Piping
nGenerator
11 Electric Plumbing ❑Sprinklers Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
d hewer Fl
Cost of Construction: $ �_7 % UtilitiesT Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name Name: CUiFT(S ,SiaamcnS
Address: R --,,Company: �lt3TGrvl >� sU S �e5
city: State: FL, Address: 141(,5 ISE �/I I 1 ae .e (� r lee Ilk p r
Zi Code: 01- ?5 Fax: City: Py lZt St , L vc(c- State: r�
P
Phone No S — 0 Zip Code: 3 -*4 52. - Fax 77a j 3 �- l ct is c
3S-323a-
E -Mail: Phone No. "I `l �L 335--313a-
RII in fee simple Title Holder on next page { if different E -Mail: u S t & I r s', S � cc o [I C c. vrn
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from the owner listed above) State or County License: Ck G C' S $ (� -
tf value of construction is $2500 or more, a RECORDED Notice of commencement is required.
SUPPLEM EN I AL CONS I RUC I ION LIEN LAW I NFORMA I ION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone:
Zip: Phone:
r
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name:
Address:
Address:
City:
City:
rip: Phone:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Countv makes no representation that is granting a permit will authorize the permit holder to build the subject structure
is in
which 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 vutork
in accordance lath 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 retarding your Notice of Commencement.
s ;
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY
OF tiS ,C L% C'-1 L COUNTY OF
i
The forgoing instrument was acknowledged efore me The forgoing instrument was acknowledged efore me
d_
this cat day 17('cr�' {y_, 20 ( b� this day •
of f of r iQY'C,� 20 _ by
� � � � i r .i sC♦• _ % ' � ' ! � '!. 1 t'v � i I ��t �71C' >'� .J I
(Name of person acknowledging) (Name of person acknowledging) 3
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(Signature of Notary Public- State of Fl .& (Signature of Notary Public- Stat of FI
Personally Known OR Produced identification Personally Known OR Produced Identification
Type of identification Produced _ Type of Identification Pro duce�7d
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Commission No. U 1 C7 5 7 : °a L`r °�°t£, CHR
CHRISTINE mission No. 7 (? tw;: a:. .. •, c
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
'
COMPLETE
INITIALS