HomeMy WebLinkAboutBUILDING PERMIT ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
S-
ouiming rermlt Hppucavon
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
F'EKMI I AI'I'LI(:A I ION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED impKovwEN I LOCAI ION:
Address: J7a7 Legal Description:
Property Tax ID 9: J S''7o6 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DE I AILF-D DF-SCRIP I ION UE WORK: i
i
CONSTRUCTION INFORMATION:
Additio aT-w— to-e errforme-d--under tFis pe�m'if—checTc all apply:
HVAC Gas T ank n�as Piping Shutters W indows/Doors
11 Electric Plumbing Sprinklers L-...!Generator Roof Roof pitch
Tota Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ yy;7 Utilities: 11SewerSeptic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name a dY1 rusekdti Name: C(; Tl s fsA4l kl,\cn --
i
P C u s Tc n1 A , r S'Ll S �e's K; i n
Address: �7 a� -P�h e�_� C<< Company:
City: $t J.CIC 1-e State: FL Address: l S E �A it �(r'eeik
Zip Code: b 44 5 _ Fax: City: PC%P-T _9t. L,c e_ State:Phone No. '1 Zip Code: 1`F1 Fax
E-Mail: Phone No. 7"�a 3 3 S 3 3
Fill in fee simple Title Holder on next page( if different E-Mail: C L( ,5 t cz i r- s s £ cz o l C c,rPti I
from the Owner listed above) State or County License: C-' ( F 10
i
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMEN IALC;ONS I RUC IION LIEN LAND INF-URMAI ION:
DESIGNER/ENGINEER: —Not Applicable + 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:
City: City: l
Zip: Phone: Zap: Phone:
i certify that no work or installation Sias commenced prior to the issuance of a permit_
St_Lucie Countv makes no representation that is r-r--nting a permit x_fill authorize the permit holder to build the subject structure
v:h ch is in conflict with any applicable Home O.:mers Association rules,b�laws orana covenants that may restrict or prohibit such
structure_Please consult.vith your Home Owners Association and review-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 with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The follmking building permit appGcat:ons are exemptfrom undergoing a full concurency review:room additions,
accessory structures,ss.4mming pools,fences,tva'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 reco-d in-you r Notice of Commencement.
Signature of 0vvner/LesseeiContractor as Agentfor O..,aer Signature of Contractor/ icense Holder
STATE OF FLORIDA # STATE OF FLORIDA
COUNTY OF _ _ i COUNTY OF
I
The for ping instrument was acknowledged before me i The forgoing instrument was acknowledged before n,e
this day of 20 Eby I this day of H i 20 i i" by
(Name of person acknowledging 1 � 1N2me of person acknowledging)
(Signature of Notary Public-State of F Cr-_:a j I (5ignature of Notary Public-State or Floriaa_4 {
- f
Personally Kno.vn OR Produced Identification personally Knavn OR Produced identification
Type of identification Produced Type of Identification Produced i
, i ;'tYPikG CF!k ;T,,
Commission No.r�f ": == - `: rq gal,�tg CHRISTINEBENUtfimission No_ 1 i f7 t•
* MY COMMISSION*�GM250
EXP[RE�Apr2 t2MI
�0/Tb0 aanaeaTisn,&x'a=TNa�ris+Ntr� r .••••. � _` ..
#F * MY COaiMiSSION GG
Rot ised 0711_.i o_G 1 - a�t
' Q,o� EEXPIRES: `
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REVIE AJS FRONT ZONING a SUPERVISOR PLANS ' VEGETATION SEA TURTLE iv1.ANGROVE �
COUNTER REVIEW REVIEW l REVIEW I REVIEW REVIEW REVIEW 1
DATE
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