HomeMy WebLinkAboutBuilding Permit ApplicaitonALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 7 - ,� /- / 9
Permit Number:
ouiiaing Yermn Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 345182
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERM I APPLICA I ION FOR: To Select from dropbox, click arrow at the end of line j
PROPOSED IMI'KUVEMEN I LUCAI ION:
Address: i�Qr/7 o vis Z/ �G
Legal Description:
Property Tax IDI#: Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
FDE l AILED UESCRIP I ION OF WORK:
Block No.
CONSTRUCTION INFORMATION:
Ad-ditiopfal work toa er orme under t is permit — check a apply: —
HVAC ElGas Tank [::]Gas Piping _Shutters �WindowsjDaars
Electric FlPlumbing Sprinklers Fi Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ ��3✓ / Utilities: 11 Sewer aSeptic Building Height:
OWNER/LESSEE: f CONTRACTOR:
Name YaiwI It J,9hrvl'-f(Oatrn5 ifu
Address: `1l b Rbrook (Zca
City: ! State: CT
Zip Code: 0(4-7 Fax:
Phone No. 203 - 612 - 9365
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: C; 0 tc -r A (K k"A C n S
Company: Cu(S-Tcm A %r- Su1SteV1'I5, i►uc,
Address: I 15 S E 1 I If dG T e'e n
City: �G 2i -_9t . !` L. ci t—, State:
Zip Code: E3-1+45.2.- Fax: `7'1,2- J-3 5-1
Phone No. '7'1 �, 33 S - 3) 3)-
E -Mail: C u S t a. I r S ti s Cr o c G art
State or County License: C C O 5 i E
tf value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMEN IALCUNS I RUC IION LIEN LAVA I -URMAi IUN:
DESIGNERIENGINEER: _ Not Applicable
+ MORTGAGE COMPANY: _ Not Applicable
Name:
j Name:
Address:
'address:
City: State:
City: State:
Zip: Phone:
i Zip: Phone:
r
FEE SiMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zap: Phone:
I certify that no .cork or installationhas commenced prior to the issuance of a permit_
St. Lucie Countvmakes no representation that is granting a permit vfill authorize the permit holder to build the subject structure
u.hich is in conflict with any applicable Home O.vrers Association rules, bylav;s or ano covenants that may restrict or prohibit such
structure_ Please consult .firth your Home Owners Association and retre_v your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I do hereby agree that 1 :vili, in all respects, perform the work
in accordance with the approved plans, the Elorda Building Codes and St. Lude County Amendments.
The follorying building permit applications are exemptfrom undergoing a full concurrency review: room additions,
accessory structures, ss.imming pools, fences, .valls, signs, screen rooms and accessory uses to another non-residential use
WARN ING 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 recoding your Notice of Commencement.
Signature of Owner/-essee/Contractor as Agent for O.:mer j
Signature of Contrac-Lor/License Holder
I
STATE OF FLORIDA ,
STATE OF FLORIDA
COUNTY OF J ' _ _
COUNTY OF
I
The forgoing instrument was acknowledged before me I
The forgoing instrument was acknowledged before me
this day of FT l7 20 `by j
i
r
this day of 7 b 20, by
(Name or person ackrov:ledging) I
(Name of person acknotvledging)
I
(Signature of Notary Public -State o; F lorica
(Signature of Notary Public- State of F cr _ia)
Personally KnovLm OR Produced Identification
OR
Personally Kno.in OR Produced Identification
Type of Identification 1
Type of identification Produced
Commission No_ _ : -: c. 8 CHRISi1NEBEN%ftmission
No. _ -~ ; :' _ _ .•.
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MY COMMISSION 3
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EXPIRES: W 4, 2UI
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FRONT ZONING SUPERVISOR PLANS ` VEGETATION
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MANGROVE j
COUNTER REVIEW REVIEW i REVIEW REVIEW
REVIEW
REVIEW j
DATE
COMPLETE
INITIALS