HomeMy WebLinkAboutBUILDING PERMIT ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
• A�
ouming rerma Application
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
PtKMI I APPLIC:AI[ON WR: To Select from dropbox, click arrow at the end of line
PHUI'U5a) IMPKWEIVI=N I LOCAI ION:
Address: LL// �
Legal Description: /6 6 /44-A h -C Dl-
Property Tax ID#: 942 5' '70 7- Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Ut I AILEU UE5CI�II'I IUN C}I- VVUKK: �
L!lt� IL-If
Pn5c, Over !0
[�CONSTRUCTIO�N INFORMATION:
wor ro
ertormed under his perms#—c ec a app y:
21
HVAC ' Gas Tank []Gas Piping Shutters F Windows/Doors
_
Electric Plumbing Sprinklers Generator - F] Roof Roof pitch
Totai Sq. Ft of Construction: Sq.Ft.of First Floor:
Cost of Construction: $ 3 /°� Utilities:I]SeweESeptic Building Height:
OWNER/LESSEE: CONTRACTOR:
Narrie Al AeA&x,, Name: C tJ+c Z t 0A c fl
Addressn G��66 /�ht � �/� Company:_ CitS-TorK A •r L4s e%i�S
City: State: Address: I&(5 S E if 11 dG r ee i1
Zip Code: 4 Fax: City: fj R-r St• L uci e- State-
Phone No. 77e1 11/1f ZZiQ Zip Code: +q51- Fax 77J �3 5 19 H
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: C u S t C,I r S s Q o [Gvyk-
from the Owner listed above) State or County License: G G' 1
tf value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SU!'YLEMEN IALCONS I RUC:II0N LIEN LAW INFURMAI ION:
DESIGNER/ENGINEER: Not Applicable l MORTGAGE COMPANY: Not Applicable
Name: Name: '
Address: Address:
City: State: + City: State:
Zip: Phone: Zip: Phone:
i -
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
I certify that no viork or installation:gas commenced prior to the issuance of a permit_
SL 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 Osmers Association rules,bylavus or and covenants that may restrict or prohibit such
structure.Please consult.-Ath your Home Owners Association and rev-.e_j your deed for any restrictions 4itiich may app(y-
in consideration of the granting or this requested permit,I do hereby agree that I will,in all respells,perform the,-.,ark
in accordance.pith the approved plans,the Florida Building Codes and St.Lude County Amendments.
The follo-wing building permit applications are ekamptfrom undergoing a full concurrency revie+.v_room additior-s,
accessory structures,su imming pools,fences,walls,signs,screen rooms and accesson,uses to another non-residential use
WARN ING TO OWNER:Your failure to Record a Notice of Commencement may resent 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 Owrier/essee/Contractor as Agent for aemer Signature of Contractor/License Holder i
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF - COUNTY OF =
The forgoing instrument was acknowledged before me The forgoing instrument was acknot-Aedged before me
this_ day of /Jj�t t ti 2O �b� this day of Mj&j4 ,30 �by j
l
(Name of person acicnc fledging) { (Name of person acknowledging)
(Signature or Notary public-Stake o F crida) (Signature Of Notary Public-State of=)orir-
i
f.
Personally Knoivn OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
c}artt'tt.�'rrU
Commission No. '- _ - .� �{� �e mission No. :
_ q�S".L^f+
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RE\,rIEWS FRONT ZONING ` SUPERVISOR I PLANS ' VEGi TA i lON SEA TURTLE MANGROVE
COUNTER REVIEW j REVIE1iV REVIEW REVIEViJ REVIE1h' REVIEW �
DATE i
COMPLETE
INITIALS