HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: b S-/ Permit Number:
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nuiliaing rermn Kppilicavon
Planning and Development Services
Building and Code Regulation Division /
2300 Virginia Avenue, Fort Pierce FL 345132
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERM I APPLICA I IUN FOR: To Select from droplaox, click arrow at the end of line
PHUPOSEL) IMPKUVtMEN I LOCAI ION:
Address:
Legal Description:
Property Tax ID #: 3 114 S- %Dz `t�l Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DEIAILED DESCRIPI ION OF WOKK:
CONSTRUCTION INFORMATION:
Additional work o b rtci me un er is permit -check all that apply:
HVAC Gas Tank []Gas Piping _ Shutters Q Windows/Doors
11 Electric Plumbing Sprinklers Generator L Roof Roof pitch
Total Sq. Ft of Construction:
Cost of Construction: $
SS ;2r'
Sq. Ft. of First Floor: _
Utilities: o Sewer F-] Septic
OWNER/LESSEE:
Name C,Dyrp.e- T �g �t
Address: ,3al3 ironwr. -
City: 7C t r 5T �_ l� C i 2 State: FL
Zip Code: Fax:
Phone No. x 0 7 6 5 1 x 0
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Building Height:
Name: Ci,'VeT(S ,5A 05
Company: 0 u s -re, n1 A sus t
Address: 1 l,^ 15 S E �/l l i dG �( r ee r1 i
City. Co R T 9t, L vci c_ State:
Zip Code: a 4-q 59. - Fax: 7'7,2- j .35- 19
(c a
Phone No. '7'1 a- 3 3:5- - 3 2- 3 1
E -Mail: C Lu 8 t& S y s Ck 0 C G vYI
State or County License: � C O 5 ( F
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SUPPLI_MENIALCONS IRUC IION LIEN LAW INFURMAIIUN:
DESIGNER/ENGINEER: _ Not Applicable
I MORTGAGE COMPANY: _ Not Applicable
Name:
I Name:
Address:
Address:
City: State:
City:State:
Zip: Phone:
i Zip: Phone:
i
' BONDING COMPANY: Not Applicable
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Z-1 p: Phone:
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 pem,it will authorize the permit holder to build the subject structure
which is in conflict with any applicable home O.vners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please consult :^nth 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 :rill, in all respects, perform the work
in accordance %.Ath the approved pians, the Floncla Building Codes and St. Lucie County Amendments.
The fol owing building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, Lva`Is, signs, screen rooms and accessory uses to another nor, -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 Owner/i_essee;`Contractor as Agent for Oxner ! Signature of Contractor/License Holder
STATE OF FLORIDA j STATE OF FLORIDA
COUNTY OF ' ; COUNTY OF
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The forgoing instrument las acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 / Lbs- J this day of Liu. 20 L by
i
l
(Name of person acknowledging j � (Name of person acknowledging)
(Signature of Notary Public- State of Fiat a j (Signature of Notary Public- Stat of Florid}
t%
Personalty Known ✓ OR Produced Identification Personally Kno-ofn OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (1-16. 1 C' l� 7�- gY ik CHRISTINEBENUH-emission No. L -r �7 t; G� a ✓�1 L' ` t^ . ?- •' - •' t
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MY COMMISSION #fG 052546
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AprO 2021
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COMMISSION* GG 652543
Re[-isedG;/1-: 2014
P\oEXPIRES:,�ti4,2o21
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REVIEWS FRONT ZONING SUPERVISOR j PLANS VEGETATION SEA TURTLE [MANGROVE
COUNTER REVIEW REVIEW I REVIEW REVIEW REVIEW REVIEW'
DATE '
COMPLETE
INITIALS
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