HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 0 -1 5-4
Permit Number.
t5miaing rermil: App icauon
Planning and Devefoprnent Services
Building and Code Regulation Division
2300 Orginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PEKMI I APPUC:A I ION FQK: To Select from dropbox, dick arrow at the end of lime
1'KOPOSEL) IMPK(JVEMEN 1 LUCAI ION:
Address: /7
Legal Description:
Property Tax ID: aI 03 �l/ Ord S Qd� s Lot No.
Site Plan Name:
Block No.
Project Name:
Setbacks Front Back: Right Side:
Left Side:
DE I AILF-U UESCKIP I ION O3 WOKK:
Aj^Se 001 fit
CONSTRUCTIONINFORMATION:
Additional work oe e rme un er is perm – c ec
11 [31–Gas Piping
a app .
Shutters F W indows/Doors
HVAC Gas Tank
_
Electric 11Plumbing Sprinklers
Generator Roof Roof pitch
Total Sq. Ft of Construction: J1 Sq. Ft. of First Floor.
Flo
Cost of Construction: $ "f a 5 Utilities:
Sewer Septic Building Height:
OWNERAESSEE:
CONTRACTOR:
Name C hr i s %9.(—�
Name: C U IET 1 S ,SA rlt YM c n S
Address: L'7 5 Cc)rLDd 0_,, iPnr�
Company: Lo-ro nit A , r LU s t ems
Address: l li 15 E Vi 11 d4_e C r ee n p i
city. F -r P, State: F�
Zip Code: q 49 Fax:
City: Fo R-T 9t, L u c{ c_ State:
Phone No.
Zip Code: Fast -J 3
E-Mail:
Phone No.
Fill in fee simple Title Holder on next page ( if different
E-Mail:
from the Owner listed above)
State or County License:
If value of construction is $2500 or more, a RECORDIM Notice of
Commencement is requkred.
SUPPLEMENIALCONS IRUC I[ON LIEN LAW INFCIRMAIIC)N:
DESiGNE
Name: _
Address:
City:
Zip:
NEER:
Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: _
Not Applicable
State
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zap: Phone:
I certjfy that no work or installation vias 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 Home Owners Association rules, b}�lau+s or ano covenants that may restrict or prohibit such
structure. Please consult with your Home Oviners Association and revie_^: 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 plans, the Florida Building Codes and St. Lucie County Amendments.
The follmkiing building permit applications are eaen-ptfrom undergoing a full concurrency review: room additions,
accessory stnirnires, swimming pools, fences, .wa`:Is, signs, screen rooms and accessory uses to another non-residential use
WARN 1NG 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
commencinET work or recordinE your Notice of Commencement.
Signature of Owner/esseejContractor as Agent for O•rrner
STATE OF FLORIDA
COUNTY OF
The forgoing instrument :vas acknowledged before me
this i5 day of Opt 20 /8 b1
L. 1y
(Name of person acknowledging j
(Signature of Notary Public- State of Fsof da j
Personally Known OR Produced Identification
Type of Identification Produced
r- Y P CHRISTINE B E
Commission No. :: L rq' `s44
* lkzLo * MY COMMISSION #
Signature of Contrac orlUcense Holder
STATE OF FLORIDA r
COUNTYOF•
The forgoing instrument was acknowledged before n.e
this /Sday of Ca/ , 20 /,1P by
(Name of person acknotvledging )
(Signature of Notary Public- State of ; loriao
Personally Known OR Produced identification
Type of Identification Produced
W mission No. ai' r r C%
G 052546 m?I�
DTIRES: WJ 4. 7021
Rei-ised 071'KV2014
1
MY COMNSSiON O GG 052548
L
oc E:XPiRES: APrU 4,2D21
RE1,'IEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW I REVIEW REVIEW REVIEW REViEW
DATE
i
COMPLETE
INITIALS -- -
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