HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
DateU — 1 - 1 S Permit Number:
.�- _..5.'. J':
ouiming rermix. App icamon
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
PEW I APPLICA 1 IUN FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPRUVEMEN I LUCAI [ON:
Address
Legal Description:
Property Tax ID #: _ J y aJ - r C)l - OV 14(4 " U b0 -(P Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back:
UE I AILED DESCRIN I ION OF WUKK:
L/l1,c /lar t.Mc yf-A
CONSTRUCTION.INFORMATION:
L_KVAC L._J Gas Tank
11 Electric 0 Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ V,� �S
OWNER/LESSEE:
Right Side:
/Oet-('
(_JGas Piping
OSprin klers
Block No.
Left Side:
�'k Adis c�P �i
. a app Y..
_ Shutters l] W indoors/Doors
oGenerator 1-1 Roof Roof pitch
Sq. Ft. of First Floor:
Utilities: 0SewerF loSeptic
Narfl
Address: `bl�l $ r'j10\\� Ct-
City: State: FL
Zip Code:,Oy%� Fax:
Phone No. I 1� o� " g I 1 - ri 02%
E -Mail:
Flt in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Building Height:
Name:
Ci,'vICZt S E,)A4W'\On:
Company:
('Lo -To m A% c St; 5 eyikS (n.; c
Address:
1&! 15 S 6yl I I as -e �( r ee i,,
City: rV 2i St . Luc{ State:
Zip Code:
a+q 52- - Fax: 7 J 3 5-151 � a
Phone No.
T11 a 'u35'3232E-Mail:
C u S t s Cc C1 1 C b w'�-
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State or County License: C O 518 ( 0
ff value of construction is $2500 or more, a RECORDED Notice of commencement is
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SUPPLEM EN I AL CONS I RUC: I ION LIEN LAW I NFORMA I ION:
DESIGNER/ENGINEER: — Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone:
Zip: Phone:
i
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address: i
City:
City: '
I
Zip: Phone: !
Zip: Phone:
I certify that no work or installation -)as 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 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 work
in accordance Mth 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 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.
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Signature of Owner/lessee/Contractor as Agent for Ow er 1 Signature of Contraci�or/License Holder
1
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF
iSZt U L'- l COUNTY OF
The forgoing instrument :vas acknowledged before me The forgoing instrument was acknowledged before me
this I day of ,M Qoq 20 j $ bt this o2 [ day of M" 20 _LS' by
Cu Aninioi7S• ('.(,L 5 Ji+IV] P"y'fA �
(Name of person acknowledging } (Name of person acknowledging) i
(Signature of Notary Public- State of Fl a } (Signature of Notary Public Stat of Flork
/ III
Personally Known V" OR Produced Identification Personally Known OR Produced Identification
Type of identificationProduced _ Type of Identification Produced
/, / W .-
tri til V 5'2 e 7 & i a° ik, CHRISTINE 8 t3! / [� cC tom' a� '� CHR4r?i .�' '.'
Commission No. mission No. * * �w;:i:. • ..••,: i i
052516
.MMYCOMMISSIONt
g EXPIRES_Aprl •2021
Reir-ised 07/15i2014 * * MYCOIdM MIdVf GG 11RM
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REVIEWS FRONT ' ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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COMPLETE
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INITIALS
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