HomeMy WebLinkAboutBUILDING PERMIT ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ol c�0 �� Permit Number
auiliaing rermn Applcation
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
PEKMI I APPUC;A I ION I-OR: To Select from dropbox, dick arrow at the end of line
PROPOSED IMPKOVEMEN I LOC:AI ION:
Address: 7
Legal Description:
Property Tax ID#: dS- 7D/— Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
UE I A1L1=U UEKKIF I ION Ql• WQKK:
d.11L ,^ /S SY�T �'�,F►�SG ov�' g/��
CONSTRUCTION INFORMATION: .
-Addft 1-workt)-Be- Dertormed under this permit-cffeck a _apply.
Gs Tank SEutte rs Windows/DaarsH E]GasV
OElectric Plumbing Sprinklers Generator Q Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor
Cost of Construction:$ 7< Utilities:OSewer OSeptic Building Height
OWNERAESSEE: CONTRACTOR:
Narne CQ+h� lyecss Name: C0IC-T S S19ML►�CnS i
Address: �a 3`7 l!h n a W10►` C t Com pang: C u s7o m f� r �U s e+ S l ru c.
City: Po Q-r S A i N L L u c i te State:FL- Address: l 1p 15 t/r 1 C�r ee r� Q
t 0 RT' S�. L yc i e: State:
Zip Code: 0 4-q Sa Fax: Cityt
Phone No. �0 �� {tar 03 `r� Zip Code: 31f1? Fax: '772- d 3 5-i 9 lc a
E-Mail: Phone No. 'I`l�L �
Fill in fee simple-Title Holder on rwDrt page(N different E-Mail: C u S t 6-i r s s 4P cz o t c c vrt i
from the Owner listed above} State or County license: G O 51 8 10
if value of construction is$2500 or more,a RECORDED Notice of Corrunencement is required. -- -
SUPPLEMENIALCUNSI RUC IION LIEN LAW INFUKMAI1UN:
DESIGNER/ENGINEER: —Not Applicable 1 MORTGAGE COMPANY: _Not Applicable
Name: + Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
i
FEE SIMPLE TITLE HOLDER: _Not Applicable ' BONDING COMPANY: Not Applicable
Name: Name:
Address: Address: i
City: City:
Zip: Phone: Zip: Phone:
I cerrtify that no work or installation has commenced prior to the issuance of a permit-
St-'Lucie Countymakes no representation that is granting a pem-at%%,ill authorize the permit holder to build the subject structure
v.hich is in conflict with any applicable Nome Owners Association rules,b1�laws or and covenants that may restrict or prohibit such
structure.Please consult:^jith your Houle Owners Association and rev;e v your deed for any restrictions which may apply.
in consideration of the granting of this requested permit,I do hereby agree that 1 Lvill,in all respects,perorm the work
in accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The folicivAng building per niit applications are exemptfrom undergoing a full concurrency review:room additions,
accessory structures,st%iniming pools,fences,.walls,signs,screen rooms and accessory uses to another non-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 reco-ding your Notice of Commencement.
Signature of Ot.ner/_esseejContractor as Agent for ONner Signature of ContractorlUcense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ! '` r _ �' , COUNTY OF 1.
i t
The forgoing instrument was acknowledged before me j The forgoing instrument was acknowledged before n.e
this day of A 0 s{: 20 IF bL- I this a 8 day of cq, U 20 (8 by
;Name of person ackrc.(edging j (Name of person acknowledging)
-/ �//�7` !'``f�li'!I. •. ���%���`t 4�"��. i
i t?LEA.. i y ✓-.. --'.,-
(Signature of Notary Public-StatE-of Fiorjda j (Signature of Notary Public-State of Florit2 }
I i
Personally Known OR Produced Identification Personally Known OR Produced Identification l
Type of identification Produced Type of Identification Produced
Y'Pyq i ,^ - •- 'aYPpi CNRIS'u.".rack
Commission No. _ =q` •'��f CNR)STiNEBENU}Iimission No -1 032S46
* * MYCOMMISStON w G 052646 1 )21
DQ'iRES_Apr2 2021
O 2aneeCTtwBudgettt�ry5wiss ---r��`•�.~Ti�, z'+7rtg�'1G�}l= -' 3MekG�
0►Tb
Revised 0:115i?Gl # * t1YC0l1MiSSiON GG052a48
P\o� EXPIRES:April 4,2021
REVIEWS FRONT ZONING SUPERVISOR i PLANS VEGE ON SEA TURTLE MANGROVE �
COUNTER REVIEW REVIEW I REVIEW REVIEW REVIEW REVIEW
DATE
COMPLE 1 E _ f
INITIALS