HomeMy WebLinkAboutbuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �l ' 3 Permit Number:
lisuming rermix Appncavon
Planning and Development Services
Building and Code Regulation Division
2,300 Virginia Avenue, Fort Pierce FL 34982
Residential
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PEKMI I APPLICA I ION I -OR: To Select from dropbox, ciick arrow at the end of line
PROPOSED IMNKUVEMEN I LUCAI ION:
Address: -17)J
Legal Description:
Property Tax ID #: 131cc:$53 — 00b ' Lot No.
Block No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
DE I AILED DESCKIP I ION OF WOKK:
S" /o'lsttl' Cl A "s `_ °''r
Glk /
CONSTRUCTION INFORMATION:Mi;ona wor o e per rmed un er Is permit - c�iec a appy:
VAC 0GasTank ❑Gas Piping _Shutters awindows/Doors
❑Electric Q Plumbing Sprinklers Generator FIRoof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: S _-3 ?"0
OWNER/LESSEE:
Sq. Ft. of First Floor: _
Utilities: 0 Sewer 0Septic
Nam `
Address:—P,Q 6 1S3 1
City: t' I V �t- P, C -'c -c Q State: �.
Zip Code:--3-LA -G51 Fax:
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Building Height
Name: CC'CcT1 S 0HaPA0n
Company: � t t� To n1 A i r S �- s t 'e
Address: i �� t$ 1%1 I i it r ee n
City: PC) 2 T ,St , L u c a State: rL
Zip Code: a+g572-- Fax: 77a. j35-i9loc
Phone No. I 'l a 33:57 -32 -32-
E -Mail:
3S -3232.E -Mail: eLt itc,Ir Sys ' Gini Ctwi
State or County License:
if value of construction is $2500 or more, a FCORDED Notice of Commencement is required.
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MW
SUPPLEMEN 1 AL CONS I RUL I ION LIEN LAW I NI-URMA I ION:
DESIGNER/ENGINEER: — Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
_
Name: i
Address:
Address:
City: State:
City: State: i
Zip: Phone:
Zip: Phone:
i
FEE SIMPLE TITLE HOLDER: — Not Applicable
BONDING COMPANY: Applicable
Name:
_Not
Name:
Address:
Address:
City:
i
City:
Zip: Phone:
Zip: Phone:
t
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 which may apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the %. ork
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The folio:►.1ing 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
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for j
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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Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contracior/License Holder
STATE OF FLORIDA / STATE OF FLORIDA .
COUNTY OF L ` L''- i L
,L COUNTY OF C%Ly .
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 3 day of/� �r
�� \ 20 Eby this 1AP�
day of ' 20 1 by
Il.. ,t 1 -rile. `{=?[7�1•�n� �tr,•�.+'yt�t'Yl a'�1G Il 5
(Name of person acknowledging) (Name of person acknowledging)
AA
(Signature of Notary Public- State of Fc; a) (Signature of Notary Public- Stat of FlorkI
i
Personally Known f� OR Produced Identification Personally Known OR Produced Identification
Type of identification Produced _ Type of Identification Produced
/
Commission No. t)7 C7 C 512 i+ 76 CHRISTINEB mission No. U1 c) EIT
a�
* * MYCOMMMON;e 31GOSM
EXPIRESAp P , 2021 PO
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Revised 07/15/201 * * h1ycommmoN; oom
E)PREs:Apra4,2021
numly now=
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER a REVIEW REVIEW ; REVIEW i REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS I
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MW