HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
dl,11lQMg t'@Piill1 Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 349182 J
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PEKM1 I APPLICA I ION FOR: To Select from dropbox, click arrow at the end of line
PKUPOSLU IMPKOVtMtN I LOCAI ION:
Address: Yfi 9 &ikelt
Legal Description:
Property Tax ID #: ����— 20,�'�Dl.Z� 0�� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DE I AILF-0 UtSCKIP I ION OF WOKK:
Xlse`r' CAJk'SC_
CONSTRUCTION INFORMATION: _
AddTfi—on—aTworl toa er rrred under this permit — check a appy:
ID
HVAC Gas Tank �as Piping _ Shutters Windows/Doors
Electric Plumbing Sprinklers Q Generator FIRoof Roof pitch
Tota; Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ -3 '�`�`3 Utilities: Sewer Septic Building Height
OWNER/LESSEE: CONTRACTOR:
Name /6*t1dAr Name: CUtCTl S ,YAn,1kti1cnS I
1 Address: Y,�Oo /3-e4d.> ac. .Qi.e.. Company: &t3 -Tom A C L4 S evv,; n;r
City: State: Address: 1 k"' 15 S E 1/l I 1 cta -e �� r ee i1
Zip Code: oZDB✓`y Fax: City: PC PLT St • L vcoe_�State: r�
Phone No. 301-410-4gLfq Zip Code: 3` 8572-- Fax: `77d- J35-i9�c
E -Mail: CA C-104 Q CLo l •Com Phone No. T1 a� 3 3:5- 313 2
Fill in fee simple Title Holder on next page ( If different E -Mail: C k a t ct i r s y 5 4-, cc n 1 C' w'_
from the Owner listed above) State or County License: G C2 51 81 / 0
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENIALCONS lRUC IION LIEN LAW INFURMAIION:
DESIGNER/ENGINEER: _ Not Applicable
+ MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone:
i Zip: Phone:
i
FEE SiMPLE TITLE BOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name: j
Address:
Address:
i
City.
City:
Zip: Phone:
Tap: Phone:
i
I cerrifythat no work or installation nascommenced priorto the issuance of a permit_
a pe?it V Vill authorize the permit holder to build the subject structure
St. Lucie County _makes no representation that is gruntingm
which is in conflict with any applicable home Ov ;hers Association rules, by-la,.s or ana covenants that may restrict or prohb- it such
structure. Please consult :with your Home Owners Association and revie_v 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 with the approved plans, the Florida Building Codes and St. Lude County Amendments.
The folioring building Permit applications are exemptfron? undergoing a full concurrency review: room additions,
accessory structures, svL4n1mi9g pools, fences, .valIs, signs, screen rooms and accessoR, uses to another nor,-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.
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Si;nature of Ov;ner/-essee;Cortracior as Agentfor O;veer
Sib ature of ContraccorJLicense Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF _
i
COUNTY OF -
The forgoing instrument :vas acknowledged before me �
The forgoing instrument was acknowledged before me
this _L day Of A) u,' -M 20l�by �
i
this / day of NclY Eir��Ja� 20/� by
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(Narne of person acknowledging j I
!Name of person acknowledging)
- '
(5ignature of Notary Public- StP t L f F .-.r.a j 1
(Sigz)ature of Notary Public- State of Flone-f
Personally Known OR Produced Identificatio_?
Personally Known OR Produced Identification
Type of Identification Produced
Type of Identification Produced
. J YP CkRIS'nNEBEN
No. -' ` �:
No.
Commission ?14-144,
MY COMMISSION 3G
�tg}}?mission
052546
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* My COMMiSstoN j GG 052:43
Revised G; i 1�i2G1=�
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REVIRAIS FRONT ZONING £ SUPERVISOR I
PLANS ' VEGiTATtON `SEA TURTLE MANGROVE �
COUNTER REVIEW j REVIEW i
REVIEW REVIEW I RR/IM' REVIEW �
DATE
f
COMPLE T E
_
INITIALS € { !
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