HomeMy WebLinkAboutbuilding permit ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
nuliaing vermi-E HPPIIcavon
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce Ft 34992
Phone: (772)452-1553 Fax:(772)462-1578 Commercial Residential
FERMI I APPLICA I ION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMEN1 WCAIION:
Address: f 50,�p
Legal Description:
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DEIAILED DESCKIPIION 01- WORK:
CONSTRUCTION INFORMATION:
Additional work o e Derformed under this permit—check all tliat apply:
UH
VAC Gas as Piping _Shutters 0Windows/Doors
11 Electric E]Plumbing Sprinklers I-.�1 Generator i..�i Roof Roof pitch
Total Sq. Ft of Construction: Sq.Ft.of First Floor:lo
Cost of Construction:$ .3 V4 ' Utilities: Sewer USeptic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Mieh,� o Art Aikm& Name: C0 VOL T1S ,YA64,oAcrt
Address:_ Y509 (;j_, Q)ttv�,1 Company: Ltr,- om A , r Su S f emI (n;C.
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City: *At St LA c i-e- State: FL Address: l( l 5 E k/t I 1 da �rye i l
Zip Code: �4 Q SL Fax: City: f"077- S t- L u cc ir state-
Phone No. Zip Code: a`FQSZ- Fax ` 1,?. 135-1 9 c
E-Mail: Phone No. 111 3 3 S - 3131
Fill in fee simple Title Holder on next page(N different E-Mail: 0- u a t ct i r 5� s £ cc a t c(.vrt
from the Owner listed above) State or County License: f} C 0 S
tf value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
;
SUPPLEMENIALCUNSI RUC IION LIEN LAW INF-URMAIIUN:
DESIGNER/ENGINEER: —Not Applicable y MORTGAGE COMPANY: _Not Applicable
Name: ` Name:
Address: Address:
City: State: I City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: ,Not Applicable
Name: Name: j
Address: Address:
City: City: j
Zip: Phone: Zip: Phone: s
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Countvmakes 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 vihich may apply.
In consideration of the granting of this requested permit, I do hereby agree that 1 will,in all respects,perform the vdork
in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The follo-vving building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,vLa'Is,signs,screen rooms and accessory uses to another nort-residential use
WARNING 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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1 s
Signature of Owner/lessee/Contractor as Agent for O,vner Signature of Contrac�or/License Holder
STATE OF FLORIDA I STATE OF FLORIDA
COUNTY OF XY L"'n e COUNTY OF^
The forgoing instrument was acknowledged before me I The forgoing instrument was acknowledged before me
this 'day of z' 20 % be this `/'day of /J " 20 by
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cn
u I- �F�ffl 1110l1 -S (.t lzT1 J j 11�1 11C- �1 5
(Name of person acknowledging) i (Name of person acknowledging)
(Signature of Notary Public-State of F°c (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
Commission No_ CHR1Si1NE8ElIG04himission No. 'L'i �'1 n ��'7 }% i:�:-: = 052i46
MY COMMISSION*f G 052546
# � EXPIRES:Apnl_ 2021 ttgrp c' 3wrlr�
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Re-vised 0;f 15i 201-f * ` * My COMMISSION JI!GG 052548
EXPIRES:A;44,2021
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REVIEWS FRONT ZONING SUPERVISOR ,1 PLANS VEGETATION SEA TURTLE I MANGROVE
COUNTER REVIEW REVIEW i REVIEW ! REVIEW REVIEW REVIEW
DATE 1
COMPLETE
INITIALS i
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