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HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFOMUSTBE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: / '%' l 7 Permit Number: J. - ouilming rermn: Appncavon Planning and Development Services Building and Code Regulation Division 2300 Orginia Avenue, Fort Pierce FL 34982 Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential PEKMI I APPLICA I ION FOR: To Select from dropbox, click arrow at the end of line PROPOSE) IMPKOVEMEN I LOCAL ION: Address: - Legal Description: Property Tax ID #?: �� l ,�Do2 ©a 77"-- Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: UE I Al LED DESCKIP 110N OF WO KK: #( i � �Yjcer �i�!►rS� ��� j CONSTRUCTION INFORMATION: Additi aT-wo-r to -be e�med under ffispermit — c ec a appy: HVAC F] DGas a Gas Tank Piping _ Shutters Windows/Doors 11 Electric Q Plumbing Sprinklers Generator F1 Roof Roof pitch Tota: Sq. Ft of Construction: Sq. Ft. of First Floor: 0 Cost of Construction: $ v�� Utilities: Sewer Septic Building Height: 1 OWNER/LESSEE: CONTRACTOR: l Name Name: C i' 'T, ,SN rt(ptic n Address- Company: Cu Tc rvt City; / 4 State: Address: I l $ �/; l .� dQ � � r ee i1 l� Zip Code:_//7041Fax: City: PO PLT ,9t, L c,c; e- J State: ��- Phone No. 6 31- do/S Zip Code: `Fq S Z - Fax: E -Mail: /h'a //� r, /9�/§ e dei tort . /> Phone No. -i 3 3:5- Fill in fee simple Title Holder on next page ( if different E -Mail: C u s t cti i r 5 y £ Cc o 1 from the Owner listed above) State or County License: �' S If value of construction is $2500 or more, a RECORDED Notice of Commencement is required. SUPPL1=i1 ENIALCONSlRUC:IION LIEN LAW INFORMA lION: DESiGNI Name: Address City: Zip: Phone: EER: _ Not Applicab FEE SIMPLE TITLE HOLDER: Name: Address: City: Zip: Phone: _ State Not Applicable MORTGAGE COMPANY: — Not Applicable Name: Ar1.trr-«- City: -- State: Zip: Phone: BONDING COMPANY: Name: Address: Zip: Phone: Not Applicable I certify that no .vork or installation llas commenced prior to the issuance of a permit - St_ 'ucie County _makps no representat=on that is granting a permit rill authorize the permit holder to build the subject structure which c is in conflict ase consult any a pilo Hom.0me Owners e Owners Association antion rev rules. It,�our deed or any restrictie s wlavis or and covenants that hich resmay apply��{t such in consideration of the granting of this requested permit, I do hereby agree that I :vii[, in all respects, perform the L:ork in accordance vAth the approved plans, the Florida Building Codes and St. Lucie Couny Amendments. The folio-::ing building permit applications are exe{r:ptfrem undergoing a full concurrency review: room additions, accessory structures, sLvimi-ring pools, fences, va`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 ricordingyour Notice of Commencement. Signature of ownerJ-esseei or ractor as Agent for O:'.'ner STATE OF FLORIDA _ COUNTY OF - - The forgoing instrument :fas acknowledged before me this =f day of 20 bbl (Name of person acknowledging j Sib ature of ContractorlLicese Holder STATE OF FLORIDA COUNTY OF The forgoing instrument was acknowledged before n,e this i V day of t' i t. , io i /- by (Name of person acknovdedging ) (Signature of Notzry Public- State of RG jda } (Signature of Notary Public -State of leric . t ; Personally KnoLtim OR Produced Identification 1 Personally Known OR Produced Identification Type of Identifiestion Produced I Type of Identification ProducedISH Yofr n =. � _' Fes;-_ �: " • r>� cHR1STINEBEN09ftmission No_ t Commission No" -- rq h{ycd}AMISSIONSfG05 W * = I w c EXPIRES: 2021 R , ���t�----q{'BH�IGLI�f{ _r aaTn,tta'trswirts* MYco�iMISStO'1#C5G�2 EXPaG3 IRES:Apr14,2021 Revised 0.-'1:V2014r .,�.�. 4 RE\,'IEAAIS FRONT ZONING SUPERVISOR PLANS ' VEGETATION SE4TURTLE IvlAt 6R0�`E COUNTER = PCE1`IEN REVIEW REVIEW REbIEVi REVIEVL DATE COMPLETE - INITIALS — ------