HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: f Z f Permit Number.
csuiliaing rermit Application
Planning and Development Services
Building and Code Regulation Division
2.3W Virginia Avenue Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential tf'
PERMI 1 APPUCA f IUN FUR: To Sebes from dropbox, dick arrow at the end of line
PliopdSLL) iMP-R,OV:LMF-N 1 LOCA I ION:
Address:
Legal Description:
Property Tax ID li: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
L)hIAlL:bU D 'RIPIION tar WOKK: `
CQNSTRUC.jON.JNF.0•..RAJIATIC?J 1;_
ono wo o e rm under is perm --Ie,,,,, app
0j 146C 11 Gas Tank [],Sas Piping _Shutters Q Window5/D0or5
❑Electric Plumbing ❑Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: J S .Ft.of R stjfl�oor
Cost of Construction:$_ VL! Utifities: Sewer oSeptic Building Height;
OWNER/LESSEE: CONTRACTOR: -
Narh 2 re,,M M401 r� (a-e>`'.� �t Name: ' G U►E"T( S ,SA ru VA o r?S
Address: J a 0`f pQ r) r r 1 n cc, (�,([Q t� W i- Company:. L s-ro nt A r 5u s erm (n:c:.
City: �aa-1 S'l P u .i-e.- � State: FL Address: I&I5 S E 1/1 I1
Zip Code: Fax: City: fco P-r 3t. L v ci state•
Phone No. 77;Z Z33 5q 5Y. Zip Code: a*4S2_ Fax 7"t,2- d 3o
E-Mail: Phone No. V7'3_ 3 3 5-3 2 3 �_
Rif in fee simple Title Holder on next,page{if different E-Mail: C u s t a`s !;:3 a o t.c 6vn
from the Owner listed above) State or County License:
If value of construction is V_%0 or more,a RECORDED Notice of Commencement is requued.
SUPPLEMEN IAL(—QN5 I RUC1 ION LIEN-LAW-INFORMAtION:
DESIGN ER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: -State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLEHOLDER: _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 priorto the issuance of a permit.
St.Lucie COL111tV 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 an6 covenants that may restrict or prohibit such
structure.Please consult.lith 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 plans,the Florida Building Codes and St Lucie County Amendments.
The foliovAng building permit applications are exemptfrom undergoing a full concurrency review:room additions,
accessary structures,sx.Ahnimin.-pools,fences,,Lvalls,signs,screen rooms and accessory uses to another non-residential use.
WARN IN TO OWNER:Your failure to Record aVotice 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,consu It with lender or an attorney before
commencing work or rico-rding,your Notice of Commencement.
Alt---v , —Z.,/ s
Signature of Owner/tessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA -, STATE OF FLORIDA
COUNTY OF IT-(.. /—C"(7 COUNTY OF LJ Cf I-t
The forgoing instrument was acknowledged before me Theforgoing instrument was acknowledged before me
this /9 day of �f-c,&f 20 /iby this 4aday of O-V4,V 20 by
t.U C m tylor? 61 Z7_11 S sil fT1 frlo rA
(Name of person acknowledging (Name of person acknovviedging)
iSignature of Notary Public-Stke of Fig a (Signature of Notary Public-Stat of Floin�o
Personally Known t.� OR Produced Identification Personally Known tl--/ OR Produced Identification
Type of identification Produced Type of Identification Produced
ISH
yp
Commission No.6l 6 0 t/6 Of�-0 5�
CHRISTINEBE11UHimission No. OWO
MYCOMISSIONS G052W
MRES.-Akri!J,2021
Revised 0;{1512014 4,202t
FRONT 'ZONING PLANS V E G ETAT I N SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
REV(EWS SUPERVISOR 0
DATE
COMPLETE
INITIALS IALS
I