HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
6 "�� Permit Number.
Date:
r _ _
ouliming rermn Hpplicavon
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 Residential
Phone: (772) 452-1553 Fax: (772) 462-1578 Commercial
PEKMI I APPL_IC:A i ION FOR: To Select from dropbox, click arrow at the end of fine
PFtOPt)SLD IMPKUVIEMEN I LQCAI ION:
Address:
Legal Description:
R
LAS/��- Lot No._._
Property Tax ID Block No.
Site Plan Name:
Project Name:
Setbacks Front
Back: Right Side: Left Side:
DE I AILED UESCRIP I ION UI- WORK:
r' Ll K y ��✓1 l qS P«
�llTe- EZ'
CONSTRUCTION INFORMATION:
ona wo o TGas
rme un er
�iVaC Tank
Electric 0 Plumbing
Total Sq. Ft of Construction:
o �
Cost of Construction: $ �7
OWNER/LESSEE:
>ermrt - c ec c a app Y
Sas Piping _Shutters
Sprinklers Generator
Sq. Ft. of First Floor* _
Utilities: 0 Sewer 0 Septic
Address:
C- 7' _Y!zState: `G
Zip Code: ��'r^ Fax:
Phone No.
E -Mail:
Flt in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Windows/Doors
Roof = Roof pitch
Building Height:
Name: Ci:�ZtS �A,A
Company:
u S-ro m A r
Address: 1(� l$ V- t 1 �� r Ie t t C�
�o P -T St . L Ci State: zip Code: Fax: Tia•
Phone No.
E -Mail: C u S t& r 5 Cc o[ C 6-,r VY,
State or County License: C �' S [ j 0
ff value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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, SUi'PLEMENIALCUNSIRUC:IION LIEN LAW iNFURiV1AIION:
DESIGN ERJENGINEER- _ Not Applicable
MORTGAGE COMPANY: — Not Applicable
Name: j
Name:
Address:
address:
City: State:
City: Slate:
Zip: Phone: i
Zip= Phone:
FEE SIMPLE TITLE HOLDER: — Not Applicable
' BONDING COMPANY: _Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zi P: Phone:
I terrify that no work or installation nas commenced prior to the issuance of a permit.
St_ Lucie County_makes no representation that is granting a permit xvill authorize the permit holder to build the subject structure
is in conflict with any applicable I✓ome O%;!re; s Association rules, bylaws or and covenants that may restrict or prohibit such
which
structure. Please consult :=nth your Nome O;'.ners Association and . evie:� your deed for any restrictions -which may apply.
In consideration of the granting of this requested permit, I do hereby agree that twill, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lude County Amendments.
The follo-. ling building per nit applications are exemptfrom undergoing a full concurrency review: room additions,
accessory structures, sssAmming pools, fences, .Malls, signs, screen rooms and accessoR, uses to another non-residential use
WARNING 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.
I
Agentfor Oeyner 1 Sib ature of Contractor,lLicense Holder
Signature of Ownerf essee,'Contracior as
1
STATE OF FLORIDA STATE OF FLORIDA r'.r
C
COUNTY OF '� i� - ! COUNTY OF .i -
I
The forgoing instrument vias acknov.-ledged before me The forgoing instrument was acknowledged before me
day 2a by
this ab day of S,�_A -t 20 �Lfby I this of �5IL7711—
i
Name of person acknowledging j � (Name of person acknovAedging )
/
II` ih ^ , /;' •/� ori - `�
L1�'[."t.�k� � _.�% `J. L'%� L� b�• `--- I 't,�,�?;'✓•- . �-� /sem �f�.`�'
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(Signature of Notary Public- State of F'io;da) ( {Signature of Notary Pu51ic- Statz of Fla , .
I�f
j i
Personally Known OR Produced Identification (Personally Known OR Produced Identification
Type of Identifica on Produced i Type of Identification Produced
J'I Y° CHRISTINEBF-Ni_ �/
Commission No. r,� G"i [' 5n iI c' Sa 00�mission No!
,A.
MY COMMISSION 81GG 652546 �'y�° t
EXPIRES: Apra 1
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Revised 07/1�i3014 ''�`- ` 31 EXPIRES:Aprnla,2021
REVIEWS
FRONT ZONING SUPERVISOR PLANS VEGETATION 1
SEA TURTLE
[v1ANGRd1'E
COUNTER REVIEW i REVIEW i REVIEW REVIEW
REVIE1b'
REVIEVI'
DATE
COMPLETE
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