HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE'INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: t�i� `/yp -Permit Number:
ouna>ing rermi-E Appiicavon
Planning and Development Services
Building and-Code Regulation Division
2300 Virginia Avenue,,Fort Pierce FL 34982
Phone:.(772)462-2553 Fax:(772)462-2578 Commercial Residential z/
PERMI I APPLICAI ION I-C)R: To Select from dropbox, click arrow at the end of line
PROPOSED IMPhOVEMENI LOCAIION:
Address: /0//7 ��f�a' �1�� rn" -
Legal Description: �—
"t
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back. Right Side: Left Side:
UE I AILEIJ DEStslfifP-1 IUN QF WORK:
C
ONSTRPCTI KINOORMATIfJN .
Acid io
work
o e er orme under this permit—check all ttiat appy:
VAC Gas Tank E]GasPiping _Shutters FWindows/Doors
OElectric Q Plumbing ❑Sprinklers OGenerator 1— 1 Roof Roof pitch
Total Sq.Ft of Construction: Sq.Ft.of First Floor.
Cost of Construction:$ 13 Utilities:0 Sewer RSeptic Building Height:
OWNER/LESSEE: CC3NTRACTOR:' :..
Name x,*,g vTta,�tl r1h ,'p dtik� Name: 6.Ui?TJ T jYA6WAc;nS
Address: 110 /_-1'1 P,tr-r rregp. Company: Ccc.3To m A ►r S L, s emS Fu t.:
City:_ `fin( ° State:FL- Address: l&I S Z E 1h l l utQ_e reeot CQ) /
Zip Code: �. yl(� Fax: City: t'O P-' 9t. L uc, r State: r--
Phone No. A01-6 9rf' /6.a 5/ Zip Code: aIf 159.-- fax: 77d- 3 35-1 q 6
E-Mail: S V'*'k"n it t- q rn' J,Go vn> Phone No. `X T3
Rif In fee simple Title Holder on next page(If different E-Mail: C u s t c..s r s 1 s p
from the Owner listed above) State or County License: Ik GC' S f 8
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
5UPPLEMEN IAL CONS I RUCI ION LIEN,LAW INFORMA-1 ION:
DF-StGNER/ENGINEEW. Not Applicable MORTGAGE COMPANY- Not Applicable
Name: Name.
Address: Address:
City: State: City: —State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLEHOLDER: —Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City
Zip: Phone: Zip. Phone-
I certify-that no utork,or installation has commenced priorto the issuance of a permit
St Lucie Countv makes no representation that is granting a permit%will authorize the permitbolder to build the subject structure
v.,hich is in conflict with any applicable Home Oriners Association rules,byla"tts orand covenants that may restrict or prohibit such
structure-Please consult%.,Affi your Home Owners Association and review your deed for any restrictinns%uhich may apply.
in consideration of the granting of this requested permit,I do hereby agree that 114AII,in all respects,perform the work
in accordance wraith the approved plans,the Florida Building Codes and St Lucie County Amendments.
The fbilo-viLi-mg building permit applications are exempt-from undergoing a full concurrency review.room additions,
accessory structures,s1wimming pools,fe-ricestualls,signs,screen rooms and accessory uses to another non-residential use
a
WARN ING TO OWNER.Yo"Ilure 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,consu It with lendef o r an attorney before
commencing urork or recarding your Notice of Commencement.
S
Tignature of orm er/Lessee; ;tOntractor as Agentf or 0,emer Signature of Contraetor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 4`1171 COUNTY OF 4s Z C=t-.
The forgoing instrumentxas acknowledged before me The forgoing instrument tvas acknoveledged before me
this j(o day Of Qgz, 20 ff—by this 6 day of QcjC_ -------120 XT by
(Name of personacknowledging (Name of person ackno%viedging)
(signature of Notary Public-State of F!9�da) (Signature of Notary Public-Statee, Nori��_Iy
Personally Knotvn OR Produced Identification Personally Krimun l OR Produced Identification
Type of identification Produced Type of Identification Produced
fS
Commission No.t; .5,-i I L� 0MMMBEN Wftnfission No.k7i-1—t 2 0
46 MYCOWMON91mame
EMRMAPra
Revised W 15/2014
EXPIRMAP4142021
RRIIRAJS SEATURTLE IVIANGROVE
REVIEW REVIEW Rmrary REVIEW REVIEW
COUNTER REVIEW -I
FRONT ZONING SILIPERVISOR PLANS VEGETATION SEA'
ffA_TE
INITIALS