HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �-16 /Y Permit Number:
s
autiaing rerma Appiicauclin
Manning 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
PERM I APPLICA I ION FOR: To Select from dropbox, click arrow at the end of line
YK_UNUSEU IMi'_KU_V_tM1=N I L_UC;_AI ION:
Address:
Legal Description:
Property Tax ID #: ySp�) — Jle? oreb ' Ara-- D Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
i
DEIAILED DESCKINIION OF WORK:
ilKe I*Kom j -td C,6►nsc,
[CO�NSTRUCTION INFORMATION: --
ona wor to nGasTank
r orme_d un er this permit---c"ieck all aPP Y
HVAC �as Piping E] Shutters Q Windows/Doors
11 Electric 11 Plumbing Sprinklers 1:1 Generator F]Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ / ' Utilities: []Sewer F1 Septic Building Height: —�
OWNER/LESSEE:
Name [iIcwA �cyf d• 110 -u -12 -
Ad d re ss:
0-u12 Address: 8C 1 7"h � t
City: S aly-cto O 3 o State: C4
Zip Code: R 5 4 0 Fax:
Phone No. '7'la 'd (b 7 & 2
E -Mail: a i V 5 'A G E arna I •Lam'
FII in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name:SNeV0ACn�
Company: 6un-Torvt A stems
Address: 15 S (: �/ I ( et C4 -r t1 T ee a—
City: �c% �t S t �- vc c J State:
Zip Code: QST. Fax: `771 � 35-I
Phone No.
E -Mail: C u S t Cc
State or County License: C' 1 F 10
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENIALC;UNSIRUC IIUN LIEN LAW INFURMAIIUN:
DESIGNER/ENGINEER: _ Not Applicable
I MORTGAGE COMPANY: _ Not Applicable I
Name:
Name:
Address:
Ad d rens:
City: State:
City: State:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name: i
Address:
Address:
City:
City:
Zip: Phone:
Zi p: 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 %•.,ill authorize the permit holder to build the subject stricture
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 All, in all respects, perform the work
in accordance with the approved pians, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exemptfrom undergoing a full concurrency review: roon; additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessary 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 Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA .�
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before rile i The forgoing instrument was acknowledged before me
this day of Cf p /u 20 I b� this i ti day of �� 20 i � by
C ti
Ci,����I; 4�f�131 inQi� � j �L%1�T1 � S.i"�YVl4�1Cif1 � I
(Name of person acknowledging } � (Name of person acknowledging )
(Signature of Notary Public -State of Florida } (Signature of Notary Public- Stat oft 10
Personally Knotvn OR Produced Identification i Personally Known I' OR Produced Identification
Type of Identification Produced _ I Type of Identification Produced
POoli
Commission No. (J -1V i` ,1 CHRISTINE 8 Etit(}imissiott No, b-1 t7 *
MY COMMISSION #f G 052546
* * c
Nr � EXPIRES: Apn1,2121 __ rpU� -- . , • -
- -- - -- 9 - — £� B�j
CI lbp� 2anAe7 Ttw Budget Hoary Semmes tD�1R•••,�+
Revised 07IT- 201 f * x . * MY COMMISSION f GG 052548
o� tac�IREs: AO1 a, 2121
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW i REVIEW REVIEW REVIEW REVIEW
DATE :
COMPLETE
INITIALS