HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /;, V Permit Number:
J
o -
auiliaing rermn App icaxion
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 ✓
NEKMI I APPLICA I ION FOR: To Select from dropbox, click arrow at the end of line
I'RopoSEL) imPKOVEMEN I LOCAI ION:
Address: �IC5 Yi u,U. I 0 DI. Ft P 0 1A aak
Legal Description:
Property Tax ID #: I q3 � - a, c ^ C' D r r, ^ O c r% --E. Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Block No.
_3.s �o✓� /VSCc� cXAi%sc_ �� ?Ali''✓
CONSTRUCTION INFORMATION: '
CHVAC "Gas Tank LPas Piping
11 Electric FlPlumbing Sprinklers
Mappty:
_ Shutters Q Windows/Doors
FIGenerator F]Roof Roof pitch
Total Sq. Ft of Construction:Sq. Ft. of First Floor:_
Cost of Construction: $ ! T10.0 9 Utilities: []Sewer[ Septic
OWNERAESSEE:
Name T, Int trust I' un �
Address: 3900 i�Cmrnvnw2ctli�l -Blvd
City: j c, 1 O h O S tee State: F�
Zip Code: 3319 Fax:
Phone No. .469- 4 6o `7 m r 519 " D%o2
E -Mail: Sic�tprl ���� e �Inr��4tiE� crOJ
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Building Height:
Name: C U lC T (S SF1 M vv� c n S
Company: Cu r> --re, rpt A �i S t e;� ( �-
Address: Ilc'LS \A ll dG-.e 4reea
City: (FO P- ,St . L v State: rt—
Zjp Code: a+,752- Fax 7%?- j.35-, 9 6 c
Phone No. Tla, 335--3)-32-
E-Mail:
35 -3) -32E -Mail: Cu st&lr Syg £ Col CGVYL
State or County License: � 4 G 0 51 F t 0
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
0 016
SUPPLEMEN I ALCC)NS I RUC I [ON LIEN LAW iNFURMAI[ON:
DESIGNERf ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
�'
Name:
Address:
Address:
City: State:
! City: State:
Zip: Phone:
i Zip: Phone:
i _
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name: j
Address:
Address:
City: '
City:
Zip: Phone:
Zap: Phone:
I certify that no work or installation h,;s 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 conflict with any applicable Home Osvr.ers Association rules, bvIaers or and covenants that may restrict or prohibit such
structure_ Please consult vkh your Horne Ov,,,ners Association and revie_v your deed for any restrictions vjhici� may apply-_
In consideration of the granting of this requested permit, I do hereby agree that I :vitt, in all respects, perform the work
in accordance with 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, sLtnmming pools, fences, signs, screen rooms and accessoR+ 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 0,vmeri.essee, Contractor as Agent for O,.'ner Signature of ContractorlUcense Holder
1t
STATE OF FLORIDA STATE OF FLORIDA I
COUNTY OF _ i COUNTY OF - —
i
The forgoing instrument %vas acknowledged before me ! The forgvir.g instrument was acknowledged before me
this day of zm e> 20 _by this /,-- day or vt ;' , 20 k,� by
i
1 I
(Name of person ackrcvrledging j (Name of person acknowledging)
(Signature of Natzry Public- Stat of Fc fla 11 (Signature of Notary Public- State o._
Personalty Knodt+n OR Produced Identification Personally Kno.�n 03 ?roduczd Identification
Type of identification Produced Type of Identification Produced
Y P CHRISTINE R Emission NQ v
Commission No_ i
____ iA�a�n
MYCOMMISSION3G052SW
m APJEXPIRES Jt.2021-
1 – --–ir�TcAYN� (;$iGl �$i
2: eC &rCg=t Nerves^t Y Sr .-•—�
Tivu
••_ * MyCOMM3SSiON#GGM2'50
Revised 0; i 1-: 2014T . 'P�o� WIREs:Apn a, mtl
r
REVIEkAJS FRONT ZONING ' SUPERVISOR I PLANS ` VEGETATION � SEA TURTLE MANGROVE �
COUNTER ;REVIEW i REVIEW REVIEW REVIEW REVIEW REVIEW j
DATE
COMPLETE
__.
—
INITiALS
0 016