HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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nuiiaing rerma Appilicamon
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce F! 349182
Phone: (772) 452-1553 Fax: (772) 462-1578 Commercial Residential
PERMI I APPLICA I ION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMYROVEMEN I L:OCAI ION:
Address: _ 5
Legal Description:
Property Tax ID #: 5 q a5
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side: _
DE I AILED DESCRIP I ION OF WORK:
Ll Ac /Dr GNtf- /ocer C/pros` OV'L /LTi L
CONSTRUCTION INFO MATION:
HVAC L JGasTank L_JGas Piping
Electric EiPlumbing Sprinklers
Lot No.
Block No.
apP y-
Shutters Windows/Doors
E] Ge nerato r F]Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
i
Cost of Construction: $ �n5 Utilities: 0Sewer _Septic Building Height:
OWNER/LESSEE: N i
Name U� �1cu ic. ►u tt • ��� �� .,�
Address: $9 SO Gy P f 55 100-k—C! 5
City:'�ip-P2t_ 1� State:
Zip Code:.750 f Fax:
Phone No. "7IJ "
E -Mail:
Flt in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name: CC,,CcTi S tJA6 yA0t73
Company:
Cc( s To m A 5 S em r n; c�
Address:
City: ro PT 9t, L- u c i t--- State: (2—
Zip Code: a+g52.- Fax: 7`77 J35 -i of lcc
Phone No. "7 'l a 3 3:5-
E -Mail:
SE -Mail: Cu'stA.ir Stis �' lxal C[h�
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of commencement is required.
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SUPPLEMEN I AL CONS I RUL I ION LIEN LAW INt-UKM I ION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: _ Not Applicable 1
Name:
Name: i
Address:
Address:
City: State:
City: State:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: — Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip- Phone: I
i
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 reviewlyour 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 vAth the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms ;nd 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 Commencementmust 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 � Signatipre of Contracior/License Holder
+
STATE OF FLORIDA - STATE OF FLORIDA f
JY
COUNTY OF ,(. U C' J C. COUNTY OF
The forgoing rostrum r• t• as acknowledged efore me The foi going instrument was acknowledged efore me
day br• this 20 by
this of Jday of
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L I r i i'f IYl i� n 5 4 i! , T l
(Name of person acknowledging) (Name f person acknowledging) i
(Signature of (Votary Public- State of Fcda j (Signa ure of Notary Public- Stat of Florklp
Personally Known OR Produced Identification Personally Known OR Produced Identification i
Type of identification Produced _ Type of Identification Produced
ssion No.MY
Commission No. U 1 C7 v `f t{ :acE, C4tR15t1NE BrG=
COMM 01BN
EXPIRES_Apr,,may yy •" _ _ �_. -;. _
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Revised 07/15i2014 * * mycommissloNf eamm
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REVIEWS FRONT ZONING SUPERVISOR PLAN VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW l REVIEN V REVIEW REVIEW REVIEW
DATE
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COMPLETE
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INITIALS
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