HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
s
ouncling rermn Appucativn
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
PF-KMI I APPLICA I ION FOR: To Select from dropbox, click arrow at the end of line 1
PKOPOSEU IMPitOVEIVIEN I LOCAI ION:
Address: �/oo Creon 6 rler- C'l p_
Legal Description:
Property Tax ID 760-4065-5-- ff0 / Lot No._
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
UE I AILLU UESC:RIP I ION OF WOKK:
11ke, l`'(' Llltc 3 sem'.. P)Ansc- -0"'- /S" s ,Sri, �jzL_"
CONSTRUCTION INFORMATION:
AddstioneFwork-to-mer ormed un ger— tFs p6_rhift=cl
HVAC Gas Tank ❑Gas Piping
11 Electric Plumbing Sprinklers
Tota' Sq. Ft of Construction:
Cost of Construction: ;70
OWNER/LESSEE:
apply:
_ Sh utters Windows/Doors
Generator F]Roof Roof pitch
Sq. Ft. of First Floor:
Utilities: oSewer Septic
Name Charles E Va�YkcIa, SAmour
Address: 7144 8 C,rulab�ler CIS
City: Fe, R_ -t S- L uc Ce, State: F`
zip Code:Fax:
Phone No. Sr7$--501-34--CL
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Building Height
Name: Lu("'TIAao'\CnL
Cam pany: Cu S -rc- m A ,.i S eWl ; i n; <<
Address: lC"lS `A I dG e tt ryeiZ
City. PO P --r :St . L , c l e_ State- F_�-
7jpCode:w4SZ - Fax: 77.?- J 35-i t !�
Phone No. -7'11 3.3 S - 3 3 )-
E -Mail: Cu StCwlr Sy 4�' Qol CGt71
State or County License: G' 51 F
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMEN IALCUNS I KUCIIUN LIEN LAW INFURIV1AI [ON:
DESIGNER/ENGINEER: _ Not Applicable
1 MORTGAGE COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City: Slate:
I City: State:
Zip: Phone:
Zip: Phone: f
i
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name: I
Address:
Address:
City: l
City:
Zip: Phone:
Zip: Phone: I
I certify that no uvork or installation h s commenced prior to the issuance of a permit_
St- Lucie Countv makes no representation that is rr.nting a permitwill gill authorize the permit holder to build the subject structure
v:hach is in conflict with any applicable Home O�: me; s Association rules, bylaws or and covenants that may restrict or prohibit such
structure" Please consult :vdh your Home Owners Association and review 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 work
in accordance with fhe approved plans, the Florida Building Codes and St_ Lude County Amendments.
Thefolimksing building permit applications are exemptfrom undergoing a full concurrency review: room additions,
accessory structures, simmming pools, fences, Lva'ls, signs, screen rooms and accessoR, 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 property_ A Notice of Commencement must be recorded and posted on the lobsite
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.
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Signature of Owneri-esseeiContractor 2s Agent for O%veer
Signature of Contractor/License Holder '-
r
STATE OF FLORIDA
STATE 01= FLORIDA
COUNTY OF _ _
i
COUNTY OF _
The forgoing instrument :vas acknowledged before me
The forgoing instrument vas acknowledged before me
this day of / 2r0 ,�b�
1
i
a
I
this day of 20 ; v by
(Name of person acknowledging) �
(Name of person acknoL ledging ) J i
(Signature of Notary Public- State of Fc, ria }- �
111
(Signature of Notary Public- State o to ic-
i
Personalty Knostm OR Produced Identification
personally Kno.vn OR Produced Identification
Type of Identification Produced
Type of identification Produced
i
, ;. yp it�tT�YPW4�
Commission No. _ _ - ?q� CHRISTWEBENC�mission
Q ir1�
No_ ; -- — .�. �••�,
* MY COMMISSION #
G 052546 l
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-- wEXPIRES.
2021 ” ,
or rd o xm,seaTm,�xs=ttrtrservms
Reused 0-111-:V2014
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MY C0MWSSIOY # GG M2:Q
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EXPIRES: a ,c APn 4, 2021
RE�'IE1l+1S FRONT 'ZONING SUPERVISOR
PLANS ' VEGi_TA T ION SEA TURTLE MANGROVE
COUNTER REVIEW j REVIEW
REVIEW 3 REVIEVY REVIEW REVIEW �
DATE
COMPLETE
INITIALS