HomeMy WebLinkAboutBuidling PermitALL APPLICABLE IINFOI QMUST BE
Date: �r�" :) l (�
COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
•
nuilioling rermix App icavon
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 349182 C�
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERM] I AI PPCA I ION FOR: To Select from dropbox, click arrow at the end of line
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PROPOSE-13IMPKOVtMIEN ISLUCAIAI ION:
Address: _— t -:;L)LA t ' cnhrl
Legal Description:
Property Tax ID #:
Lot No.
Block No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side:
Left Side:
DI: IAILtU OF -SCRIP IION OI- WOKK:
lq5e . c Q,, -I' .S'/tk./
CONSTRUCTION. INFORMATION:
ona wo o e e rme un er is perm — c ec
�i HVAC Gas Tank []Gas Piping
a app
Shutters 11 W indows/Doors
Electric Plumbing Sprinklers
_
En Generator Q Roof Roof pitch
Total Sq. Ft of Construction:
Sq. Ft. of First Floor:
0SewerL ]Septic Height:
Cost of Construction:$ c%6.i�� Utilities:
Building
OWNER/LESSEE:
CONTRACTOR:
Name ��F I
Name: CU�Z1S SArutv\C(I I
&5-r-& nit Ar s U S eVlla
r
Address.J �►X�--C
State: Tr
Company: -
Address: 14' Is s E V, I l �( r e i1
city,Tcrel CCmC(l
Zip Code: Fax:
City fro RT St . L uci e_ State:
2,
Phone No. '� {� — 7�- � (�- 1
Zi p Code: 3-` q 52. - Fax: 77d ,j 3 55- igi l<
E -Mail: �r
Phone No. 1 `► �
Fail in fee simple Title Holder on next page { if different
E -Mail: u S t i r S ti� Cc n i c a vrt
from the Owner listed above)
State or County License:
-
if value of construction is $2500 or more, a RECORDED Notice of Commencement is "uir -
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SUPPLEMEN IAL CONS I RUC I ION LIEN LAW INFORMAI ION:
DESIGNER/ENGINEER: — Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
address:
City: State:
Zip: Phone:i
City: Sate:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: — Not Applicable
Name:
BONDING COMPANY: _Not Applicable
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County makes no representation that is granting a permit k_'ill authorize the permit holder to build the subject structure
:h :cls is in conflict with any applicable Home O.uners Association rules, bvlativs or and covenants that may restrict or prohibit such
structure. Please consult with your Home Ovulners Association and reviews 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 vAth the approved pians, the Florida Building Codes and St_ Lucie County Amendments.
The follmk)ing building permit applications are exen ptfrom undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, .��a'Is, signs, screen rooms and accesson, uses to another non-residentiai 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.
s
Signature of Owner/Lessee;'Contraciar as Agent for O:vner !Signature of ContracforjLicense Holder
i
STATE OF FLORIDA _ I STATE OF FLORIDA
COUNTY OF ` r' ! COUNTY OF
3 i
The f going inst� Hier•.t wlas acknov:ledg- efore me The forgoing instrument was acknow,•ledged-hefore m.e
this day of _ e . 20 \ bt I this day oto 4 CC 2(- by
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I
n
(Name of person acknov.iedging j (Name of person acknowledging)
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(Signature of Notary Public- State of Rooda ' (Signature of Notary Public- State of Flo
'
1
Personally Known OR Produced Identification— Personally Known OR Produced Identification
Type of identification Produced I Type of Identification Produced
!: Yv I ,1 )rvuo,� r.NKta-a:r s} 1'
Commission No- t37 Gi J�� iq `gat,' CHRISTINEBENQtftrnission No. oC 511 ` i-'`;=? •' •: • = ? 1
* * W OMMISSION# G052546 * t l
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crwo aandetlTlwBudget Na7ry5eMres t ...•1—� tiRgENGL1Fi
Ret'ised 0,'/1513014 ` * MYcoMMISSION#GG 05250
EXP1lEs:W4,2021
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