HomeMy WebLinkAboutbuilding permit ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date. AD Permit Number:
W Maw.
t mialing Yermix /Appication
Planning and Development Services
Building and Code Regulation Division
2300 Yrginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential ~
PEKMI I APPUC:A I ION I-OK: To Select from dropbox, click arrow at the end of line
PROPOSEL) IMPROVEMEN I LOCAI ION:
Address: ! 7 7 lit,_
Legal Description:
Property Tax ID#: a 0,3-' �l-Q�,Z,J ooQ�,s Lot No.
Site Plan Name: Block No
Project Name:
Setbacks Front Back: Right Side: Left Side:
[UHAILEL) L)ESCKIP ON Ol• WQKK:
Glke I/A 3�'0� ���«/ ��P►�sc o /c�/iuJ
CONSTRUCTION INFORMATION:
A(lditional work to e rme un er is permit-check a apply__
[aHVAC Gas Tank []Gas Piping _Shutters Windows/Doors
Electric Q Plumbing Sprinklers U Generator a Roof Roof pitch
Total Sq. Ft of Construction:
// Sq. Ft.of First Floor-
Cost of Construction: $ �7��rS'i Utilities:F� n
Sewer LJ Septic Building Height
OWNER/LESSEE: CONTRACTOR:
i
Name Name: C U�T i S ,St1 n1 y� rt S
Address: 1776 4 a/%n 6��ndf r Company: C u S 7a n1 A r s S, eM, [ c:
city: 6,1 t A-&u E State: FL Address: r ee 11 p �
Zip Code: 4 Fax: City. ('U PLT Sty. L uct g_ State: (am- l
Phone No. Zip Code: Fax: 77,7- J 3 f S-m
E-Mail: c✓lv i Phone No.�f no7irl4 r ;
Fill in fee simple Holder on next page{if different E-Mail: e 4 S t C,i r
from the Owner listed above) State or County License:
i
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. 4�
SUPPLEMENIALCUNSI RUC i[ON LIEN LAUD INFURMAIIUN:
DESIGNERJENGINEER: _Not Applicable 1 MORTGAGE COMPANY: _Not Applicable
Name: ; Name:
Address: '' Address:
City: State: I City: State:
Lip: Phone: i Zip: Phone:
i
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable i
Name: Name:
Address: Address:
City: City: I
Zip: Phone: Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit_
St_Lucie CountVmakes no representation tf.at is granting a permit e_fill authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Assaaat-ion rules,bl-latvs or and covenants that may restrict or prohibit such
structure.Please consult s.fith your Home Otvners Associction and review your deed for any restrictions which 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 i.Ath the approved plans,the Florida Building Codes and St.Luce County Amendments.
The following building permit applications are eaemptfrom undergoing a full concurrency review:room additions,
accessory structures,sLvinirning pools,fences,:va`is,signs,screen rooms and accessoRs 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 properfi/.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 reco-ding your Notice of Commencement.
Signature o OOE+.tert esseejContractor 2s Auent for O:vner Signature of ContmucirlUcense Holder
STATE OF FLORIDA _ STATE OF FLORIDA i
COUNTY OF f _'r'- i COUNTY OF
The forgoing instrument:vas acknowledged before me 1 The forgoing instrument was acknowiedged before nne
this_�day of P�Ae&`l 20 0—by this A S day of C,!Izi 6,9 , 20 by
I
tl. it L rllr;j r
(Name of person acknowledging) i (Name of person acknowledging)
(Signature of Notary Public-State of Fcrft3a) ( (Signature of Notary Public-Sfate'of Florira
Personally Known OR Produced Identification Personally Kno-wn OR Produced Identification
Type of Identification Produced Type of identification Produced
yp CPR
Commission No_( 66,�' ,� 4 fK ?q` `�1 CHR1S21NE B E►?I1lemission No. ' �7 it z o 0525?G
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Rey ised G; 1_.i 1 EVIRES:Aprf 4,202t
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REViEWS FRONT ZONING SUPERVISOR i PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW I REVIEW REVIEW REVIEW REVIEW
DATE �
COMPLETE f
INITIALS