HomeMy WebLinkAboutBuilding Permit ApplicaitonALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ��` ®^� Permit Number:
nuiicatng rermix tappncavon
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34582
Phone: (772) 452-1553 Fax: (772) 462-3578 Commercial Residential
FERMI I APPUC:A I ION FOR: To Select from dropbox, click arrow at the end of line
PROI'USEU IMPKOVLMEN I LUC;AI ION:
Address: ---
Legal Description:
Property Tax ID #: /,Y//- 7n� -oDly"'/)�)o -J, Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
j
UE I AILED UtSC:KIN i ION OF WORK:
(�i/ ` c �1�� LI k t- �'%✓� I S S� f f C'/1 %� �S � � J i Sr�t �,/
CONSTRUCTION INFORMATION:.
AdditionalworktobeDertormed under this permit —check a app :
[]Gas Piping Shutters Q Windows/Doors
HVAC Gas Tank _
Electric Plumbing Sprinklers Generator Q Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
< Height
FICost
of Construction: $ Utilities: Sewer Septic Building
OWNER/LESSEE:
CONTRACTOR:
Name 711y7c)/tul
Name:
Address: .dU II ®er Rd,
Company: eu3Telm A \ c Su S t CYKS n c:
_v%7�
Cit},: , •� State:
Address: 5 SS E 1%i I 1 da -e �_ i r ee n, 0
`
Zip Code: 0 /� Fax:
City: 6 R t 9t, , L (., c(c.• State: r- —
�
Phone No.
Zip Code: + `{ 4 52- - Fa)c 77a 3 5- I �r c
E -Mail:
Phone No.�-
Rif in fee simple Title Holder on next page { if different
E -Mail: C LA S t C' i r S ti s C< o l
from the Owner listed above)
State or County license: R G L? S l
Commencement is required.
If value of construction is $2500 or more, a RECORDED Notice of
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SUPPLEMEN IALCONS I RUCIIUN LIEN LAW INFORMAI IUN:
DESIGN ER/ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
_
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone:
Zip: Phone: !
i
FEE SIMPLE TITLE HOLDER: — Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: 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
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 4vhich 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 folim-Ang 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.
Signature of Owner/ essee/Contractor as Agent for O.vner Signature of Contractor/License Holder 1
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF XY tl (' j fr COUNTY
OF
i
The forgoing instru rt was acknowledged efore me The forgoing instrument wasacknowledgedc/before me
this day �Q�'
of 20 /bv this day of Ma,f`f"/ L 20 �!_ a by
• Cru I^ �; a to mc7n`'
L 1ZT1 5 SYS t'i'i aT1161 11 J
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public- State of a } (Signature of Notary Public Stat FI
of
ttt i
Personalty Known v' OR Produced Identification Personally Known �� OR Produced Identification
Type of Identification Produced _ Type of Identification Produced '
Commission No. lTl tT! Q 5�t ,5 7 ° CIfRI577NE 8 mission No. Li
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTERREVIEW REVIEW i REVIEW ? REVIEW REVIEW REVIEW !
DATE
COMPLETE
INITIALS
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