HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
csuiming rermix Hppiicavon
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1.578 Commercial Residential
PEKMi I APPLILA I ION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPKOVEMEN I LOCAI ION: _
Address: c6 M u 1 I 4 (Lt) C I'I >
Legal Description:
Property Tax 1D #: 331a: _ �C%9 - d 01� - 0 C -K) (
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
IDE: I AILED DESCKIP I ION OF WOKK:
Lot No.
Block No.
CONSTRUCTION INFORMATION:
Adait 'al work o be performed un er this permit - check 5!T-- f
pp
HVAC I Gas Tank Gas Piping hutters F Windows/Doors
11 Electric 0 Plumbing 0Sprinklers Generator FIRoof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $
OWNER/LESSEE:
Sq. Ft. of First Floor:
Utilities: 0 Sewer[] Septic Building Height:
Name /LC, CIO
Address: 1)62.
�-
City: �2rt 3 ; nOU)A-h State: _
Zip Code: O,� S 7 i Fax:
Phone No. '� C_ 1 - 5d q - 2" 9 (0
E -Mail:
RIi in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Name:
CureTt ; ,S»rL1ky\cnS
Com pang:
C U 37G m A r s u stems
Address:
11� t:5 S Ey, t i d -Q -.e r ee a �� l
Com: PD P -T St . L vci State: r�-
Zi pCode:
L - +q 5�2_ - Fax: 77,2- d 3 5-
Phone No.
T-1 a 3 3:5- - 3 2 3 2
E -Mail:
0u 6rxtr 5y5 £ Ccoi r c,
State or County License: C C, 519 10
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENIALCUNSIRUC IION LIEN LAW INFORMAIION:
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:
Zip: Phone:
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 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 pians, 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, wails, 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 rec ding your Notice of Commencement.
Signature of Owner/lessee/Contractor as Agent for Owner
Signature of Contractor/License Halder
STATE OF FLORIDA
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STATE OF FLORIDA
COUNTY OF ,C U (F 1 e
COUNTY OF
The forgoing instrument was acknowledged fore me
The forgoing instrument was acknowledged before me
this ,-�` L day of J)J61 20 Lby
this -I day of 20 1 by
eurbs 'ntrmon s-
I"TI 5 �14YI14'non S
(Name of person acknowledging }
(Name of person acknowledging)
(Signature of Notary Public- State of Flg(a)
(Signature of Notary Public- Stat of FloridaX
Personally Known ✓ OR Produced Identification
Personally Known OR Produced Identification
Type of Identification Produced
Type of Identification Produced
Commission No. Ui (� 5� 7� cja' CHRISTINEB
mission No. lJt C7 oC 5'7 �� ��� ��; a • '
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`oma DCPIRES:AW 4, 2021
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REVIEWS FRONT ZONING SUPERVISOR
PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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