HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: s ' Ufa Permit Number:
auiiaing rermix App icamon
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-3578 Commercial Residential
PEKMI I APPLIC:A 1 ION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED I_MYKU_ V_E�Mn EN 1 L:UCA I ION:
Address: �S 113 I 1 l- � T
Legal Description:
Property Tax ID #: 3 LA aS rlC('P f C)2 35 - Ude - 11
Site Plan Name:
Lot No.
Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DEIAlLED UESCKIP110N OF WO KK:
L/ke 14,% 1-!/<e icy /ylsee( out It, /fr•�
CONSTRUCTION INFORMATION:
-Cdyffic"V611 woro e ei rme un er is perms -- c ec a appy:
C Gas Tank Deas Piping _ Shutters Windows/Doors
Electric CD Plumbing ❑Sprinklers D Generator D Roof
Total Sq. Ft of Construction:
Cost of Construction: $
OWNER/LESSEE:
Sq. Ft. of First Floor:
Utilities: D Sewer D Septic
Name >C3`yvl�`� �-� c�� M -
Address: 41l flIQCC�2 )
City: X00 to State: \ C -
Zip Code: 3�a5 0� Fax:
Phone No.
E -Mail:
RII in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Building Height:
Roof pitch
Name:
C U VC T I S PYA 4, v\ 0 n S
Company:
Ou 3 -re, m A, r S L, S � eVKS_ n c�
Address:
&'t 5 S E \Zi I 14-9 -e �( r ee i1 Q r
City: Fy R -T 9t . 1.., uct e_ State: r-�
Zip Code:
a+1752- Fax: 7`7a J 3 57- i 9 � F
Phone No.
T1 a 3 3:5- - 3 z
E -Mail:
C o s t C, f r 5 `t S�p a C, C c, vn-
State or County License: e, G 0 51 $ 0
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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: !
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name:
Address:
Address:
City:
City: i
a
Zi p: Phone:
S
Zip: Phone:
I 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 Horne 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 with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exemptfrom undergoing a full concurrency review: room additions,
accessory structures, swimming 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 recoding your Notice of Commencement.
5
Signature of Owner/ essee/Contractor as Agent for Owner Signature of Contractor/License Holder 1
STATE OF FLORIDA <<, STATE OF FLORIDA
COUNTY OF U L'- i COUNTY OF
I
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this �'�' day of M�, 20 by this� Zday of 20 t$ by
i' `
� Iti �l S s t4Yv M0 rA S
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pubblic- State of FfCt a) (Signature of Notary Public- Stat of Flori
✓
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
OppCommission No. ttt C7 Dl✓ :d CHRISTINE mission No.� oc ✓�7 �%' '�� per;:
* • MYCOMMISSIONA G052646 0 j
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Re��ised 07/1�i301 EXARES•AprA4,2o21
REVIEWS FRONT ZONING SUPERVISOR I� PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW { REVIEW REVIEW REVIEW REVIEW
DATE
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COMPLETE
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INITIALS