HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
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tstUti aing YerMIX ApPlIcavon
Planning and Development Services
Building and Code Regulation Division /
23oo Virginia Avenue, Fort Pierce FL 349182Residential
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial __
PERMI I APPUC;A i I0N I -OR: To Select from dropbox, click arrow at the end of line
�-. �� �nwuuttVi-M4-AII i{H�Alit?N:
Address: ld 11)VeCA-e5s W�
Legal Description:
QLot No.
Property Tax ID #: �30�! o`�' w�oD �__
y Block No.
Site Plan Name:
Project Name:
Setbacks Front
Back: _Right Side: Left Side:
UI:I AILED UIESCRIP I ION UE WOKK:
L //"r- Is,r LIKE- �•S-�'An /YS<<� �;,(�►�SG o"� �!'
CONSTRUCTION INFORMATION: .
rmun er is permit -
fiuu�uvi
VAC Gas Tank DeasPiping11 _Shutters
DzLJ
Electric 11Plumbing OSprinklers OGenerator
Total Sq. Ft of Construction:
Sq. Ft. of First Floor:
Cost of Construction:$ 3/ � — Utilities: 0 Sewer[] Septic
OWNER/LESSEE:
Name #au ¢
city. %4_State:
Zip Code: 3 q �6 Fax:
Phone No.
E -Mail:
RII in fee simple Title Holder on next page ( if different
from the owner listed above)
CONTRACTOR:
DWindows[Doors
DRoof = Roof pitch
Building Height
Name: CL'�ZIS ��M�ncnS -
S tem`'
Company: u s m
Address: 105 , . L vet Is E �i l l ��ee a p/
Po tzr -qe_ State:
ode: 3�45� Fax ILL dzip C
Phone No. i `1 3 3:5 - 3 2 3 2
E -Mail: C u S t r s Cc n 1 C [, vm
State or County License: G o S (8
tf value of construction is $2500 or more, a RECORDED Notice of Comr "eWient is req°ked'
SUNI'LI MtNIALCONS IRUC IION LIEN LAW INFUHMAIION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: — Not Applicable
Name:
Name:
Address: I
Address:
City: State:
Zip: Phone:
City: State:
Phone:
Zi
Zip:
I
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name:
Address:
Address:
City.
Z-1
Z p: 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 v:ill authorize the permit holder to build the subject structure
rules, bvIay.s or and covenants that may restrict or rpr hib+t such
which +s In conflict with any applicable Nome Owners Assoc ton
structure. Please mnsuit :^nth your Nome O>':ners Association and review your deed for any restrictions vah+ch ma apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respecrts, perform the �:ork
in vrith the approved plans, the Florida Building Codes and St. Lucie County Amendments.
accordance
The folio,,king building permit applications are exenmptfrom undergoing a full concurrency review: room additions,
and accessory uses to another non-residential use
accessory structures, swimming pools, fences, wa`ls, signs_, screen rooms
Commencement may result in your paying twice for
WARN 1NG TO OWNER: Your failure to Record a Notice of
improvements to your property. A Notice of Commencement must be recorded and posted on the iobsite
before
before the first inspection. If you intend to obtain financing, consult With lender or an attorney
commencing work or recording your Notice of Commencement.
Signature of OE: ner;'_esseejContractor 2s Agent for O:vner 1 Signature of Contractor/License Holder
1
I STATE OF FLORIDA
STATE OF FLORIDA
5 <<` L`' % COUNTY OF
COUNTY OF
The forgoing instrument was acknow;edged before me
The forgoing instrument was acknowledged before me {){
J/UL y 20 by 1 this day of _sTU7 20 / l� by
this day of
I
` t �I �yt� In ►nc;(( trLC fi,Tl J �,f} 1'!'t 4't'1C� i", .J
L � � .;'
(Name of person acknowledging)
(Name of person acknowledging ;
•/ 1 �
1 �-- //' / '
t / /-z,/
Notary Public- State of Fitt a } { (Signature of Notary Public - Stat of Flor'
(Signature of
Personally Known OR Produced Identification Personally Known `/ OR Produced Identification
,Type of Identification Produced
Type of Identification Produced_ oo,
J �Q09 PGNFCF�?'u `e =r'
cHtusnNEBEN iiimission No_
No. 6 6 0 5 1,5 !✓
Commission rgaKa
MYCOMMISSION #fG062546
N 1�`r E�tRES:`I^Y .21)2t 1�Y •+f61rF3iH.���� --•
-- 9 - Se^rires -- r •,` Vn -
au,,Ak Tivu Mget Hatay
MY COMMISSION $ GG 062644
I s:apila,zo2t
Revised 07/155/301 > .oma
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REVIEWS FRONT ZONING SUPERVISOR) PLANS VEGETA; ION SEA TURTLE MANGROVE
REVIEW REVIEW
COUNTER REVIEW REVIEW ! REVIEW REVIEW
DATE
COMPLETE —. — —
INITIALS I ---- - - --�
052546
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