HomeMy WebLinkAboutBuilding PermitALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
•
ouliming rermu Hppllcavon
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 T—
NEKMI I APPLICA I ION FOR: To Select from dropbox, click arrow at the end of line
YROI'OSEU IMYKOVEMEN I LOCAI IOM:
Address:
Legal Description:
Property Tax ID #: '3//;d `h� Z -®0` s l��d Lot No.
Site Plan Name:
Project Name:
Setbacks Front
Back: Right Side: Left Side:
DEIAlLED L)ESCRIP 110N OF WORK:
U/T c_
CONSTRUCTION INFORMATION:
7 ddTtionFwor ci to be errmimed -under tYis permit = cl
iVAC F] Gas Tank []Gas Piping
11 Electric 1:1 Plumbing Sprinklers
Tota: Sq. Ft of Construction: Gj
Cost of Construction: $� / S
OWNER/LESSEE:
Block No.
apply:
1:1_ Shutters []Windows/Doors
E] Generator F]Roof Roof pitch
Sq. Ft. of First Floor:
Utilities: Sewer Septic Building Height:
CONTRACTOR:
Name C74 o ° / />' -- MRrK C Name: C, it + T (; ,SN h�01\C n
Address: % br Com pany: u S?o tvt l� �� 5 PVs2 ; n c�
City: le r Lf7` yr C State: Address: 167" 1:5 cta 'r ee a
Zip Code: ✓`t 7 Sol Fax: City: IQG 2T =St, Lucie_ State:
Phone No. ��%l�-•�i��f ���� Zip Code: 13-I+g52- Fax: 77J- J-5-19
E -Mail: Phone No. T1 a- 3 3 S- 3 3
Fill in fee simple Title Holder on next page { if different E -Mail: C u 5 t C1 1 r 5 ti 5 f- C, o 1 [ C, ITI_
from the Owner listed above) State or County License:
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMEN I AL CONS l RUC I [ON LIEN LAVH I NFURIVIA I IUN:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: — Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone:
Zip: Phone:
i
FEE SIMPLE TITLE HOLDER: Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name: j
Address:
Address:
i
City:
City:
Zip: Phone:
Zip: Phone:
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I certify that no .pork or installation ;gas commenced prior to the issuance of a pemit
St_ Lucie Countvmakes no representation that is granting a permit will authorise the permit holder to build the subject structure
v:hich is in conflict with any applicable Home O.vners Association rules, bylai.s or and covenants that may restrict or prohibit such
structure_ Please consult :Ah 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 1 will, in all respects, perform the work
in accordance vAth the approved pians, the Florida Building Codes and St_ Lurie County Amendments_
The follovAng building permit applications are exemptfrom undergoing a full concurrency review: room additions,
accesson structures, s.Amming pools, fences, wa'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.
s
Signature of Ownerf-esseefContractor as Agent or O::rner � Signature of Contractor/License Holder 1
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF _
1
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before n:e
this 16' day of ND k' '20 by 1 this /S day of /�/p V , 20 1 by
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1 ;
(Name of person ackrc.Aedging } I (Name of person acknov,!Iedging )
(Signature of Notary Public- State z:�F cr:fia j (Sigilature of Notary Public State of :=loris:- j i
Personally Knodvn OR Produced Identification Personally Knmvn OR Produced Identification
Type of identification Produced Type of Identification Produced
��aY,'�{�y% I f� rt VPs p4, CHRIsT: "' ' 14
- CkRISTINEBENt�i{rmission No. +7 " 0 r- '- r-• --'
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Commission No- _: _ _ i
MYCOMMISSION3 PG052%6
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Revised 0711-'V2014 TT��.o� EXPIRES: Apm'4,2021
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REVIE\n1S FRONT ZONING SUPERVISOR i PLANS VEGEf ATION SEA TURTLE Ivi.ANGROVE �
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COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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COMPLE T E
INITIALS
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