HomeMy WebLinkAboutbuilding Permit Application- backpageALL APPLiCABL�IE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
tsuiiaing rermix iAppiication
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
PhKMI I APPUCA i ION FOR: To Select from dropbox, click arrow at the end of line
PRUPOStU IMPKOVEMtN I LUC:Ai ION: _.
Address: 7Yt -p &'1'4 =rz
Legal Description:
Property Tax ID 4: C00 - 3 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back:
UE IAILEL) L)LSGKiP i ION OF WORK:
1191419 11y�1t_
4ti ki"
CONSTRUCTION INFORMATION:
Right Side: Left Side:
ona work to be rtormeo unoer tnis perms: -C'
HVAC Gas Tank Gas Piping
Electric 11 Plumbing ❑Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
aShutters aWindows/Doors
11 Gene rato r FIRoof
Sq. Ft. of First Floor: _
Utilities: 0 Sewer OSeptic
OWNERAESSEE: CONTRACTOR:
Address: 1019QTY //Ll y -y
city: 2dA- 'kc x,•c'� m' State: / 1
Zip Code: Fax:
Phone No.
E -Mail:
Fill In fee simple Title Holder on next page ( if different
from the Owner listed above)
Building Height
Roof pitch
Name: C,U -[iS 1.)Atit0A0n
Company: `u s-ro m !� � 4 S �WIS 1 ti c:
P Y�
Address: d.a.z C r?_C p
City:
f'v FZ7 St , L uci State: rL-
Tu p Code: ti34 52 - Fax 7 `7a7 j 3 S- t 9 lr
Phone No.
'7'1 x 315- 5-- 3 2 3 �-
E-Mail: t&ir
T
State or County Licenser C C? 5 f
i
if value of construction is $2500 or more, a RECORDED Notice of commencement is required.
SUPPLEMEN I AL CONS I RUC I ION LIEN LAW INFORMAIION:
DESIGNER/ENGINEER: — Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
_
Name: j
Address:
Ad dress:
City: State:
City: State: j
Zip: Phone:
Zip: Phone:
I i
FEE SIMPLE TITLE HOLDER: — Not Applicable
BONDING COMPANY: Applicable
Name:
_Not
Name:
Address:
Address:
City:
City: 1
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
which is in conflict with any applicable Home Owners Association rules, bylaws or and that
covenants 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 svork
in accordance vilth the approved pians, the Florida Building Codes and St. Lucie County Amendments.
The foliorling building permit applications are exemptfrom undergoing a full concurrency review_ room additions,
accessory structures, swimming pools, fences, wails, 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.
• �"
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s
Signature of Owner/ essee/Contractor as Agent for Owner
Signature of Contractor/License Holder i
STATE OF FLORIDA
COUNTY OF i % C'. I
STATE OF FLORIDA
COUNTY OF
The forgoing instrument sata,� acknowledged efore me
The for g f
going instrument �ti+a acknowledged before me
this day of %i.6I✓ 20 /, by
this day of� 20 / by
( T"l J +�LI%�Y►'I Fti`1C% Yl S
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary Public- State of Fl a)
(Signature of Notary Public- Stat of Flo i
i
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification Produced
Type of Identification Produced
Commission No. HT1 6 D �,� S �l � CHRIVINE B
mission No. (31 � J � iJ c� ✓ jr 1
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GOSHtEIRES_AprO
.2021
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Revised 07115 201
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REVIEWS FRONT ZONING SUPERVISOR 1
PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW !
REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
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INITIALS •