Loading...
HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: ( .. (� Permit Number: � I owilaing rermix Appimaxion Planning and Development Services Building and Code Regulation Division 2300 Virginia Avenue, Fort Pierce FL 34982 `/ Phone: (772) 452-1553 Fax: (772) 462-1578 Commercial Residential PERM I APPLICA I ION FOR: To Select from dropbox, click arrow at the end of line 1, PROPOSED IMPROV_EMENI LUCAIION: Address: 0 -3 rne0,/Dto le' ra-ru� Legal Description: Property Tax ID ##: 3 g 61 z5 -? d 4 Q R -060 0dQ ._ a Lot No. Site Plan Name: Project Name: Setbacks Front Back: Right Side: Left Side: UE I AILED UESCKIP I ION U!- WOKK: /©A� CONSTRUCTION -IN FORMATIOW. Additional worK toBe er orme un er is permtf= cl AC Gas Tank ❑Gas Piping 11 Electric Q Plumbing 0Sprinklers Total Sq. Ft of Construction: Cost of Construction: $ Block No. F=Shutters aWindows/Doors 11 Generator F]Roof Roof pitch Sq. Ft. of First Floor: Utilities: E]Sewer0-Septic Building Height: OWNER/LESSEE: Name J �1^n v.S M h r" Address:90 _,C1U4.J /6Lr" lC- e -M. City:�r'f St tune State: Zip Code: L9Q4?,5a Fax: Phone No. % i a - 3,59 E -Mail: Fill in fee simple Title Holder on next page ( if different from the Owner listed above) CONTRACTOR: Name: Ci'YtTIS PAjoipvtcn.a Company: Cu 3Ta rK A% r S t., S t frK S c- Address: 1k -,t5 S 6 Vt l( da -e reen City: 00 Rr ,St . L vct,c State: rL Zi p Code: a+17 52- Fax: 771 d 3 5- i 9 a Phone No. `I'l l 335 - 323 E -Mail: Cu St&Ir stiS �� CcaCbt'n State or County License: C 0 5 f 9 10 is ff value of construction $2500 or more, a RECORDED Notice of Commencement is required. ISH 05254+3 )21 UVIM SUPPLEM EN I AL CONS I RUC I ION LIEN LAW I NFORMA I ION: DESIGN ERf ENGINEER: Not Applicable ( MORTGAGE COMPANY: _ Not Applicable Name: Name: 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: Zip: Phone: 1 certify that no work or installation has commenced prior to the issuance of a permit. St. Lucie 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 Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such structure. Please consult with your Home Owyners Association and review your deed for any restrictions which may apply. 1n consideration of the granting of this requested permit, I do hereby agree that 1 will, in all respects, perform the work in accordance Mth the approved pians, 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, m screen rooms and 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 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 ovvner/ essee/Contractor as Agent for O:+mer Signature of Contractor/License Holster STATE OF FLORIDA STATE OF FLORIDA COUNTY OF e a L°/ COUNTY OF I The forgoing instrum r• :� as acknovaledged efore me The forgoing instrument was acknowledged efore me this day of 20 �b`' this / day of 20 by o f T i p S/4 YY 016, fl � (Name of person acknowledging } (Name of person acknowledging) / �l �Jl aYlU' ) y i (Signature of Notary Public- State of F? a) (Signature of Notary Public- Stat of Flo III �� Personally Known OR Produced Identification Personally Known OR Produced Identification Type of identification Produced _ Type of Identification ProdLu�ced 1[/ L aper r ' cNk►S?s;.� , },' iTt C7 5 7 b ?ajYap CHRISTINE 8s/ 1,5q Commission No. mission No. * * MYCOMMISSION# 052548 *� - EXPiRES:Apol t2021 :. �0/1` eontlea7tru8�getNap�Ysuvkms t .•"': Re1i-ised 0-1/15i2014 * * MYcduMls ON#C-4 EXPIRES: Apro 4, 2021 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW i REVIEW REVIEW REVIEW REVIEW DATE i ! COMPLETE i s INITIALS ISH 05254+3 )21 UVIM