HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
ouiliaing rermn Hpplicavon
Planning and Development Services
Building and Code Regulation division
2300 Virginia Avenue, Fort Pierce FL 34982 `
Phone: (772) 462-1553 Fax: (772) 462-1.578 Commercial Residential
PEW I APPLIC:A i ION FOR: To Select from dropbox, click arrow at the end of line
pROPOSED IMPROVEMEN I LOCAI ION:
Address:
Legal Description: Tv Q
Property Tax ID #: ego Y I Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back:
UE I AILI=u DF -SCRIP I ION 01- it1 OM
Right Side: Left Side:
Block No.
CONSTRUCTION INFORMATION:
AdditionalWOrKTOpeperformed un er is permit - c ec
a app
O WindowSjDoors
1VAC Gas Tank Gas Piping
_Shutters
11 Electric Plumbing Sprinklers
Generator Ll Roof Roof pitch
Total Sq. Ft of Construction:
_
Sq. Ft. of First Floor:
oSewer a Height:
Cost of Construction: $ `� <� Utilities:
Septic Building
OWititER/LESSEE:
CONTRACTOR:
Name l�obin R lch
Name: CU�TlS ,SArV0\0(1
Address: a a k IGiM b
Company:nt'
City: FO tit poli! 2� State: rL
/
Address: I l l S S V i l 1 d
Zip Code: � 4 9 4' � Fax:
� 1 0lZT St . L u ct State:
Phone No. 510 1- 33-9- G r1 �4 5
Zip Code: 3 X150. - Fax: 777- J-357
E -Mail:
Phone No. I q� 3 3:5, - 3 2 3 2
Ril in fee simple Title Holder on next page ( if different
E -Mail: C u S t & l r 5 TS 4�1 a o (c. vn
from the Owner listed above)
State or County License: C 4 C O
If value of construction is $2500 or more, a RECORDED Notice of CommeWment is required-
SH
Aws
SUPPLEMEN IALCUNS I RUC iION LIEN LAW INF-UhMAIION.
DESIGN ER/ENG INEER: — Not Applicable
1 MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
i Address:
City: State:
City: State:
Zip: Phone:
Zip: Phone:
FEE SiMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name: l
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
1 certify that no work or installation as commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit Evill authorize the permit holder to build the subject structure
which is in conflict with any applicable Nome Owners Association rules, b��laws or and covenants that may restrict or prohibit such
structure. Please consult .4kh your Horne Ov.ners Association and reviet^i your deed for any restrictions vihich 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 eyith the approved pians, the Florida Building Codes and St. Luce County Amendments.
The follmkiing building pern-it applications are exemptfrom undergoing a full concurrency review: roorn additions,
accessory structures, sv.4m :Ting pools, fences, :Aea`ls, signs, screen rooms and accessory uses to another non-residentiai 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 recording your Notice of Commencement.
5
Signature of Owner/LesseelContractor as Agent fey O..ner j Signature of Contractor/License Holder i
i
STATE OF FLORIDA f STATE OF FLORIDA r� .
COUNTY OF COUNTY OF
The forgoing instrument :pias acknowledged before me I The forgoing instrument was acknowledged before n,e
this day of -- Sc �a t 20�b� I this S day of -"0by
I
(Name of person acknowledging ) ( (Name of person acknov.ledgino )
4.1
(Signature of Notary Public -State of Ficidda) (Signature of Notary Public- State'of Flori!10
-.
Personally Krim-LinORProduced Identification Personally Kro.vn OR Produced Identification
Type of Identifiestion Produced_ ! Type of Identification Produced
/ -- �� � .ri - : - r . - �,RY P(7p4 CF!RIS•ti: [ '-, r t
Commission No- (_rt ("i Y CHRISTiNEBEN 1-
L n c4 lig No. �r �' C% a
?q`e iihmission
MY COMMISSION 8 GG 052346 *S i
a'
EXPtRES_Apr�. 2021 Y p :o
- r�� ft-
;,,:
0►►b wnAedTixuBudgetlataryServirrs r
* MY COMMISSIONS GG M2W
Ret-ised G7 /15i3014 �-.�.
EXPIRES: 4,2u1
REVIEWS
( I
FRONT ZONING SUPERVISOR PLANS = VEGETATION
SEA TURTLE
I
iv1ANGROVE
COUNTER REVIEW REVIEW 1 REVIEW REVIEW
REVIEW
REVIEVl•-
D ATE
COMPLETE
FlNi�ALS-- --- — -- - i -- — - - - 1
SH
Aws