HomeMy WebLinkAboutBulding Permit applicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: C) ^1 Permit Number:
nuiming rermn Kppncavon
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 APPLICA I ION FOR: To Select from dropbox, click arrow at the end of lime
i
PROPOSED IMPRUVEMEN I LUCAI ION:
Address:
Legal Description:
Property Tax ID #:
�
Lot No.
Site Plan Name:
Block No.
Project Name:
Setbacks Front Back:
Right Side: Left Side:
like �y'r L��/l C', ��I"^ IVSeei �h✓�►�Sc. oma' P" It
CONSTRUCTION iNFORMATIOW
Ae4r,nnaT wnrk fn hp nprtnrmL%d under this eermit — ch eC all tNat 8001V:
0HVAC H Gas Tank LJGas Piping U Shutters
Electric 0 Plumbing L3 Sprinklers 11 Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor: _
Cost of Construction:$ Utilities: oSewerF�Septic
aWindows/Doors
F]Roof Roof pitch
Building Height:
OWNERf LESSEE: CONTRACTOR:
Nar�e Name:
C o YET(
Address: r Z ( parry: L 5-ro m A% r- S u s t ems (n; c-
City: �` �n"��l �e. State: �L, Address• I 15 1%1 tiQ4 ��>^ee t1 /
Zip Code: ,OJk� Fax: P°v (ZT S� . ci State: f
Phone No. 'i I.2L - �,T4 �::Z) - Zip Code: Fax
E -Mail: Phone No. i 3 3 5- 3 .�- 3 o-
Ril in fee simple Title Holder on next page { if different E -Mail: C u s t c- i r s I '5--:E a r ( - ( c. Gn _
from the Owner listed above) State or County License: C° G O 5 ( F ( c)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMEN IALC:UNS i RUC IION LIEN LAW INFURMAI IUN:
DESIGNER/ENGINEER: _ Not Applicable
i MORTGAGE COMPANY: Not Applicable
Name:
_
1 Name:
Address:Address:
City: State:
I City: State:
Zip: Phone:
i Zip: Phone:
I
_
FEE SIMPLE TITLE HOLDER: _ 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 prior to the issuance of a permit.
St_ Lucie Countymakes no representation that is granting a permit will authorize the permit holder to build the subject structure
a:hich is in conflict with any applicable Home Owners Association rules, or and covenants that may restrict or prohibit such
structure. Please consult :^pith your Home Ovuners Association and re;rie v your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, 1 do hereby agree that I will, in all respects, perform the e.ark
in accordance v_Ath the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The follo,kling building permit applications are exemptfrom undergoing a full concurrency review: room additions,
accessory structures, stiL4mming pools, fences, va?Is, 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.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE , .
I
COUNTY OF t ' r / e COUNTY OFORIDA
The forgoing instrument :vas acknowledged fore me The forgoing instrument was acknov.-ledged before n.e
this \t) day of ( Ids: i this U day of CC.i-4C�C)Q(' 20 1 by
R� In I)'tG,il I
(Name of person acknowledging) (Name of person acknowledging)
!
(Signature of Notary Public- State of Fiodfcia) (Signature of Notary Public- State of Fioric_. .t
Personally Known OR Produced Identification Personally Known OR Produced identification I
Type of identification Produced Type of identification Produced
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REVIEWS FRONT ZONING SUPERVISOR I PLANS VEGETATION I SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIE\A' REVIEW
DATE
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COMPLETE
INITIALS — —
ISMS
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