HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
_! p Permit Number.
Date: 0
'now DUtiaing Y@rMlT Application
planning and Development Services
Building and Code Regulation Division
23oo Virginia Avenue, Fort pierce Ft 34982 Residential
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PEKMI I APPUCA I ION FOR:
To Select from dropbox, dick arrow at the end of line
., .awussr�v�tvll-N t i 0C Al ION:
rrwry ��......... - -
Address:
Legal Description:
z ��� Lot No.___
Property Tax ID #: L7C 7- 106?7�- Block No.
Site Plan Name:
Project Name:
Back; Right Side: Left Side:
Setbacks Front
UE I AILED UESLKIP I IUM UE IA OM
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CONSTRUCTION_ INFORMATION: .
ono wo o e rm ur ei Is permit -c ec a a
pp
Gas Tank []Gas Piping _rs
HVAC
nnklers Generator
Electric 1:1 Plumbing n USP
Sq. Ft. of First Floor: _
Total Sq. Ft of Construction: /s n
Cost of Construction: $ __ S�Z 7 S Utilities: 0 Sewer 0 Septic
OWNER/LESSEE:
Name Thow1,%S a r0 -TCA t(
Address: Q 21 Q i � w. mole {
City. �c 2T S r I. V c �- State:
Zip Code: VL2" Fax:
S
77a Gal- 4080
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
QW indows/Doors
Roof = Roof pitch
Building Height:
G U "0 T l S ,Sp rLt V'Y\ c n S i
Ne:
am1
lu3 Gtti1 s S Lem`
Cam pang:
Address: 1 !Q l 5 C� r ee n, p
Pv 2r g't . E u c t c ` State:
3rf452- Fax: `7`72-
Zip Code:
Phone No.
-1` � { r S CL C G NL
E -Mail: C u s 5($ I 0
State or County License:
If value of construction is $25oo or more, a RECORDED Wtice of Commencement is req&ed.
SUPPLEM EN I AL GUNS I RUL I IUN LILN LAW I NLUKMA I IUN:
DESIGNER/ENGINEER: — Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
State:
City: State:
Zip: Phone:
City:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: — Not Applicable
' BONDING COMPANY: _Not Applicable 1
Name:
Name: j
Address:
City:
Address:
City:
Zip: Phone:
Zip; Phone:
I certify that no work or installation °seas commenced prior to the issuance of a permit.
representation
Asssociation rules�Jtlatvs or and permit holder
that matld y restrictorproct hibit such
o is
which is no onfli t with any 1-ome
structure. Please consult ith your Horne Ov ners Association and reyie+•� 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 v:crk
in accordance vAth the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The follor:ing building permit applications are exemptfrom undergoing a full concurrency review: room additions,
and accessory uses to another non-residential use
accessory structures, swimming pools, fences, %PLa`ls, signs, screen rooms
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
Commencement must be recorded and posted on the Iobsite
improvements to your property. A Notice of
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.
"V s
Signature of O+'rner essee/Contractor as Arent for O:vner Signature of Contrador/License Holder
STATE OF FLORIDA j STATE OF FLORIDA
COUNTY OF ) i % C' % E_ COUNTY OF
The for oing instrumer•.t :vas acknovaledged before me The forgoing instrument was ackno�ardged before me
y 20 l by
this � day of 2018 b�' I this day of rTU�
I
(J C I" t In Irl (-,?I I �+ Tl
j � (Name of person acknowledging)
(Name of person acknowledging
I,k/��/yam J `/ � i� �'2.��'�{., �-✓ /"" ��a! 4�'� �• i
of Notary Public- State of Flgr a j (Signature of Notary Public- Stat of Flo
(signature
e j
Personally Known OR Produced Identification Personally Known / OR Produced Identification j
Type of Identification Produced ;
Type of Identification Produced_ Puo CH.R1,
ff Yv CHRISTINEBENC�lfhmission No. �'1 �7 �� c(J�7 '
6 �1
Commission No. t21 �I ✓,� b ?q e 4
* MY COMMISSION #GG 052546 m; xT _
�r c EXPIRES: Apd14,2021_o4RY?L�.—.C.HRRY11Vt:-liENGLiSH- ._ _ ,
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EXPIRES: APM a, 2021
Rex i sed 07/1-5i2014 "��
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGi TA T ION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW
COUNTER REVIEW REVIEW1 REVIEW
DATE
COMPLETE
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INITIALS -- ---
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