HomeMy WebLinkAboutBUILDING PERMIT ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: (o -�il Permit Number:
t5miafng Yerma Appiicavon
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PF-KMi f APPLICA I ION FOR: To Select from dropbox, click arrow at the end of line
1'ROPOSEU IMPKUVEMEN I LOC:AI ION:
Address: �D1
Legal Description:
Property Tax ID#: ��D3-02�1- 0O1?1,�"' 0��`s Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DE I AILEU UESC;KIP I K)N OF WOKK:
L11ce �y9c Lll�c �1'�n . l�{S<<r 19k�' C'�l►��'s� ��'C,
CONSTRUCTION INFORMATION:
Additional work o e er rme under is permit-check a app :
[]HVAC FI Gas Tank ❑Gas Piping _Shutters Windows/Doors
11 Electric 0 Plumbing Sprinklers Generator Q Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ ��� 13- Utilities: Sewer a Septic Building Height
OWNERAESSEE: CONTRACTOR:
Name �01ak,,f U rO ChkN Name: C U yt T I t-v\c i l s --- -�
i
Address: i15 5 Co lkn ti Company: ("S?'e,a A emn s [ A.
City coat PtQ/LCJ� State: Address: t 1 15 E i1r l i dG �(reer2
Zip Code: 3q-q S Fax: City: (co r 9t. L vc(e-- State:
I
Phone No. $Ua- 535-RalL1 Zip Code: 3-`f?5 -- Fax: 7L2- J35-1c c
E-Mail: Phone No. 11�L
Fit)in fee simple Title Holder on next page( if different E-Mail: C u S t C-L i r- s y s Cc C, C c.M
from the Owner listed above) State or County License:
tf value of construction is$2500 or more,a RECORDED Notice of Commencement is required. _
SUPPLEMEN IALCUNS I RUC IION LIEN LAW INLURiVIAI IUN:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: j Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address: l
City: City: i
Zip: Phone: Zip: Phone:
I certify that no work or installation=1as commenced prior to the issuance of a permit.
St.Lucie Countv makesno representation that is granting a permit kvill 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 arils,in all respects,perform the work
it.accordance with 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 accessoR,uses to another non-residentiai use
WARN ING TO OWNE R: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 retarding your Notice of Commencement.
Signature o OOwner/"-essee/Contractor as Agent for O,vner Signature of Contractor/License Holder
STATE OF FLORIDA ,. I STATE OF FLORIDA
COUNTY OF 5 t {. _ '`r it COUNTY OF -F-
I I
The forgoing instrument was acknowledged before me I The forgoing instrument was acknowledged before n e
this s�day of TLt/I e 20 /Av this'day of by i
(Name of person acknowledging j (Name of person,ackno:.,ledging)
1041
(Signature of Notary Public-Ste/te`of F/Gr.}rla} (Signature of Notary Public-State/of rlori
Personally Known OR Produced Identification__ Personally Kno-wn r/ OR Produced Identification
Type of Identification Produced_ Type of Identification Produced
Commission No.irl 6 u('✓�� & ?q a ° CHRISTINEBENWIn-fission No. L7 t= 4, �J�7
MY COMMMION#f G D52546 :•:- - ! )2S
a _ c EXPIRES:{�r`d,.1021
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0►ib Budget '�C� CHR �BEN�
0 2o;f9edTiw 13u et Ha'1ry Services 2• n
Revised G ilSi2G1 �* MY COMMISSION#GGo52W
EXPIRES:April 4,2021
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETAT ION SEA TURTLE MANGROVE j
COUNTER REVIEW REVIEW ! REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE I
INITIALS i
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