HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: //-
Permit Number:
s -
numing rermi-E App icaxion
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 349182
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
NtKMI I APPLIC;A 1 ION FOR: To Select from dropbox, click arrow at the end of line
PKOPOSEU imPK0v1=MEN 1 LOCAI ION:
I
Address: Vr� i�aZ a2gfi �e
Legal Description:
Property Tax ID #: 3�t'f7� $® %' ��,J.�"' ���
Lot No.
Site Plan Name:
Block No.
Project Name:
Setbacks Front Back: Right Side:
Left Side:
Ut I AILtU DESLKIP I ION OF WOKK:
Oa � k
CONSTRUCTION INFORMATION:
Additio twor o e er rmed un er this permit — c ec
AC Gas Tank ❑Gas Piping
X[]
a app :
_Shutters Windows/Doors
11 Electric D Plumbing Sprinklers
1:1U Generator R Roof Roof pitch
Totai Sq. Ft of Construction:
Sq. Ft. of First Floor:
Cost of Construction: $ 3 i I Utilities: F—1 Sewer Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name
Name: C U i'E? T I S ,.SF} 44, pJAc n S
Address: J� u
Company: & S a m A r S t el K -s c-
i
City: 1r�>Af %�,ll�t.('�. State: _0L
Address: 1&15 S E reert j
Zip Code: Fax:
City: IP02'r 9t - Luca State- rte--
Phone No. Z7.1 2199
Zip Code: 3Fax: `77�- J 3 5-19 6 II
E -Mail:
Phone No.
Fill in fee simple Title Holder on next page ( If different
E -Mail: C u s t _k i r s y s 4:.- Q o I c [l vm
from the Owner listed above)
State or County License: C� C O 5 181 l
I
If value of construction is $2500 or more a RECORDED Notice of Commencement is required.
SUPPLEMEN IALC ONS I RUC IION LiEN LAVA INFUIiMAI [ON:
DESIGNER/ENGINEER: _Not Applicable
f MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
,address:
City: State:
City: State:
Zip: Phone:
i Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name:
Address:
Address: i
City:
City '
Zip: Phone:
Zip: Phone:
I certify that no .fork or installation alas commenced prior to the issuance of a permit -
St. Lucie Countymakes no representation that is r-r-.nting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules, b�_ laws or ana covenants that may restrict or prohibit such
structure. Please consult :vith your Home Owners Association and revie`_v your deed for any restrictions vihich may apply.
in consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the v.ork
in accordance k,Ath the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The follo-.king building permit applications are exemptfrom undergoing a full concurrency review: room additions,
accessory structures, sti4mming pools, fences, :.,a'ls, signs, screen rooms and accessory uses to another non-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.
Signature of Ov;neri-essee/Contractor as Agentfor OL:,ner I
Signature of ContractorJLicense Holder
STATE OF FLORIDA 1
STATE OF FLORIDA
COUNTY OF
COUNTY OF -
The forgoing instrument was acknowledged before me �
The forgoing instrument was ackno+•:ledged before me
this day of NO ✓ 20 1 bb`_ I
i
this day of Idsy , 20 ! by _
(Name of person acknc.:ledging ) I
(Name of person aclmosvledging
i
1
(Signature of Notary Public- State of Fcr;ria
(Signature of Notary Public -State of=lotira i
I
Personally Known OR Produced Identification
Personally Kno-wn OR Produced identification
Type of Identification Produced
Type of Identification Produced
Commission No. f:i +L - c; a c CHR1STMEBEN
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mission No. t....
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MYCOMMIS510N #
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