HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
% ��
• DUIIAIrIg Y@fRli-E AppilCavon
Planning and Development Services
Building and code Regulation Division
2300 Virginia Avenue, Fort Pierce F! 34982 Residential
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
pRaPU_SEDIMPKOVEMENI LOCAIION:
Address:
Legal Description:
Property Tax ID #: A.
S -62
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
UE I AILED UESCRIP I ION OF WORK:
CONSTRUCTION INFORMATION:
Aad-,tiona wor to a er clT ecr—dn er is t permit ---Cl
�IVAC n-- Gas Tank [:]Gas Piping
11 Electric ElPlumbing Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
OWNER/LESSEE:
Lot No.
Block No.
app y: ers []Windom ws
WindoJDoors
Generator F]Roof Roof pitch
Sq. Ft. of First Floor: _
Utilities: ElSewer 0 Septic
Name r 10-0 1 V �
Address: 3 7A Lf 1,�,) hlz�
City: �0llt Sit �LtC i 2 State: F
Zip Code: 3 `i c(; � Fax:
Phone No. '17 a 313-85f,;-
E-Mail:
13-85`]d-E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Building Height:
Name: Ci'CT ( r �)A46 01c0
u n7c rvt r s cr S t
Company:
Address: l& -'I5 SE I.i dG 6/reei1
City: PO �-T St . Luc i IC— State: r�—
Zip Code:Fax:
Phone No. i'l� 33S
E -Mail: Cu 5tclill r sys
State or County License: C 0 S l
If value of construction is $2500 or more, a RECORDED Notice of commencement is required.
SUNNLLM i=N I AL C:UNS 1 KUL I lUN LILN LAW I Nf-UKMA 1 tU I`d:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State: I
City: State:
Zip: Phone:
Zip: Phone:
r
FEE SIMPLE TITLE HOLDER: — Not Applicable
BONDING COMPANY: Not Applicable
(
Name:
Name: i
Address:
Address:
i
City: i
City:
Zip: Phone:
Zip: Phone: ;
I certify that no work or installation has commenced prior to the issuance of a permit.
St. I ucie 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 tome 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 r.crk
in accordance vAth the approved pians, the Florda Building Codes and St. Lucie County Amendments.
The follovAng building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimining 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
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 O•riner I Signature of Contractor/License Holder !
STATE OF FLORIDA STATE OF FLORIDA
OF
COUNTY OF !COUNTY _t
i !
The forgoing Inst; umert :vas acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 td bv this 3o day of Am n . 20 l by
i —
i
6'� 1G
f i S .� R fit t lorj S' t tt IZT1 J It t?'1 YA
(Name of person acknowledging) � (Name of person acknowledging )
lc/ti
(Signature of Notary Public- State o€ fl ! da) (Signature of Notary Public Stat of Flo '
III
/
Personally Known OR Produced Identification Personally Known OR Produced IdentiFcation
Type of Identification Produced Type of Identification Produced i
_ j .Z b - !- ! �Y PSG CHRV-M-•:e
Commission No_ ii7 ' ✓ �/ I - qa•`Y CHR15T1NEBENGWin-tission No. lir L7 !r U� c� J �7 �' *
l�`c
r MY COMMISSION t�G 052516 <:
EXPIRES: April 2021YP ' -`-'.- !
"BENGUW --
Banded Ttw Budget Noa+y Servirr tt : o
olto * MYCOMMISSIo, GG 052544
Re -vi sed0;il-5l3G1 °��� c� EXPIRES: April 4, 2021
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW ` REVIEW REVIEW REVIEW REVIEW
DATE
i
COMPLETE
INITIALS i