HomeMy WebLinkAboutbuilding permit ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPT ED
Date: �! ' " ( Permit Number:
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t uilialing Nermii AppiIIcavon
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 `f
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PEKMI I APPLICA I ION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPKOVEMEN 1 LUCAI ION:
Address: tl c� 1 On,f
Legal Description:
Property Tax lD#: 2.�Jy3 Z ` U(ZJZS-, (�)QO " S Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DE I AILED DESCKIP I ION OF WORK:
V, hoc- L.� ` � ayr�. G
uD OL:,v
CONSTRUCTION INFORMATION:
-Ad aitio a wor_to Ge er ormed under tFiis per`mTt-cHe-6 a app y:- - ----^
llVAC Gas Tank Gas Piping _Shutters a Windows/Doors
11 Electric F]Plumbing Sprinklers FI Generator Q Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ QI�) Utilities: 11 Sewer Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name C--,P %z- C sj Name: C L. iL T I ,SA rA V\c I �—
Address: ! 7 1 l (ZjC, (- �-VC LC'�PO C U) Company: Ct,u 3-tc m A , r S
City: �-nC A- 'i':Q-c-CP State:1:—::*t.— Address: l 4c 15 ,S' A'T
3�1�S Fax: City: �c 2T �t. Luc; State: (_L--
Zip Code: y: i
Phone No. .rl''12 3nZ - 3�{� — Zip Code: 4+q5,) Fax rjU J-3 57 i ci !�
E-Mail: Phone No. "� 3 5-
- 3 2
Fill in fee simple Title Holder on next page{ If different E-Mail: C u :3 t e,i r s yam£ fc c I i'll-
from the Owner listed above) State or County License: C O 51
ff 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 NFURMA I ION:
DESIGNER/ENGINEER: _Not Applicable I MORTGAGE COMPANY: _Not Applicable I
Name: Name: i
Address: Ad d ress: i
City: State: City: State:
Zip: Phone: Zip: Phone: i
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 reviety 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 foliovling building permit applications are exemptfrom 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/lessee/Contractor as Agent f or Owner Signature of contractor/License Holder i
3
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STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
i
The forgoing instrument was cknowledged before me The forgoing instrument was acknowledged before me {
this 0 day of_t-"S 0.rC 20 11by this 30 day of t_\,C-Jr C.�-- 20 by
• Lur tgnitY1on5. T1 S 11mo-\&n S
(Name of person acknowledging j (Name of person acknowledging)
(Signature of Notary Public-State of Fir (Signature of Notary Public-State/of Flo
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced _ Type of Identification Produced
D 5,2,5 � �d A 4 0 515 q C os"
�`►nr pr c++r� =ii M "�, S
Commission No_ CHRI571NE8 mission No. * # ��;:�:•• ..•�.=t
* * MYCOMMISSION# 052516 m :•:• )21
EXPIRES:Aprd 4.2021 "
''aorry BWWednwsuaPurawySWA=
Revised 07/15i2014 * * COMMMoNtGf ORM
`ar E)RRES:Mr84,2021
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REVIEWS FRONT ZONING SUPERVISOR j PLANS VEGETATION SEA TURTLE MANGROVE
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DATE
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