HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: // 'S • / Permit Number:
ouilming rerma iAppllcauon
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce Ft 34582
Phone: (772) 462-1553 Fax: (772) 462-3.578 Commercial Residential
Yi oposEU IMI'KovwEN I LOCAI ION:
Address: "� `� / lSC Q r"� e- t7
Legal Description:
Property Tax ID #:-,3 qa7 7 7�Q - 0ec;_ 7 - 000
Site Plan Name:
Lot No.
Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Ut I AILED UtSCRIP i ION OF WOKK: l
CONSTRUCTION INFORMATION:
AdditionaFi-work to -be er�med under t��s permit = Check a
HVAC Gas Tank ❑Gas Piping
Electric El Plumbing Sprinklers
L—I Shutters F Windows/Doors
F1Generator F]Roof Roof pitch
Tota': Sq. Ft of Construction: Sq. Ft. of First Floor: _
Cost of Construction: $ S-;�Z S J Utilities: Sewer Septic
OWNER/LESSEE:
Name a -r r e' r Co
Address: r'l c E Q ref
City: UC! C State: �L
Zip Code: f v2 Fax:
Phone No. RO 7 -13 7c;L-
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Building Height:
Name: LuK"T1 S f A oACnJ,
Company: C u�, Tc rK A r- suis e;`K
Address: I S E et r �� r ee a
City: (G R -T =St . L uci e- State -
Zip Code: 3 H -Q52.- Fax: 7T2- J, 35-1 of �
Phone No. T1 a- 3 3:5-- 3 0- 3 a -
E -Mail: C o s t Cl i t S y s f- ct c- I C G VM
State or County License: � C O 5 f E l C)
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMEN IAL CONS 1 RUCTION LIEN LAVA iNFORMAI ION:
DESIGNER/ENGINEER: _ Not Applicable
+ MORTGAGE COMPANY: — Not Applicable
Name:
Name:
Address:
'1 Address:
City: State:
! City: State:
Zip: Phone:
; Zip: Phone:
i
FEE SiMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Ad d ress :
Address: i
City:
City:
Zip: Phone:
Zip: Phone:
I certify that no ��ork or installation 'spas commenced prior to the issuance of a permit;
St. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflictwith any applicable Home O,:mers Association rules, b�>Iay.s orana covenants that mak restrict or prohibit such
structure_ Please consult -Ath your Horne 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 1 will, in all respects, perform the work
in accordance v.4th the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The follmkiing building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory.- structures, slou4ni ting pools, fences, :��a'Is, signs-screen rooms and accessory 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/-esseeiContractor as Agent for O:vner j
i�
Signature of Contrac-Lor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA ;
COUNTY OF
COUNTY OF
The forgoing instrument vias acknowledged before n e f
The forgoing instrument was acknowledged before n,e
this _1� day o; lQG ve M1Qg t 20 _LYby 1
this 5 day of M V C rYLfaR - 20 I by
(Name or person acknowledging j �
(Name of person acknovv!ledging )
_ ._
.. -
_ L:� i
(Signature of Notzry Public- Stale of F crl_;a
,
(Signature of Notary Public -State o, lonay f
Personally Known OR Produced identification
Personally Known OR Produced identification
Type of Identification Produced `Type
o, Identification Produced
F
�
_ .r�` � ++
Commission No. Gi t: f _ _ 2yYa°y CHRISTINE BENCftmission
_
, t � _- - - ITxYPUi4 CF!K1�?iiti' ilia
No. i =: =" =
MY COMMISSION #G
052646 l
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UPTRE S_Apra t
2021 -
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EXPIRES: Apn14, 2021
REVIEWS
FRONT ZONING SUPERVISOR i PLANS 'VEGETATION
SEA TURTLE
MANGROVE i
COUNTER REVIEW j REVIEW REVIEW REVIEW
i REVIEW
REVIEW i
DATE
COMPLE i E
INITIALS -
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