HomeMy WebLinkAboutBuilding PermitALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: N
Permit Number:
•
numung rermix Appucavon
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 345132
Phone: (772) 402-1553 Fax: (772) 462-1578 Commercial
Residential
j FEW I APPLICA I ION FUR: To Select from dropbox. click arrow at the end of line
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Address: 7;_ S 4 Wj,,,t
Legal Description,:
Property Tax ID #: 39a �- 6Ci a-
Lot No.
Site Plan Name:
Block No.
Project Name:
Setbacks Front Back: Right Side:
Left Side:
UE I AILI=U UESCRIP I ION OF WORK:
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��p r►S e-- P a k ✓
CONSTRUCTION INFORMATION:
- a won to e e rme un er t !s perm!t - c ec
HVAC ❑Gas Piping
a apply:
Shutters WindowslDoors
( Gas Tank
_
U Electric U Plumbing Sprinklers
[]Generator 17 Roof Q Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
' / �
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Cost of Construction: $ 7 Utilities:
Sewer _Septic Building Height
—
OWNER/LESSEE:— ---- - l
CONTRACTOR:
Name
Name: Cis it -T1 S 5S; ty,oAC n
nn
Address: 7z 15-1
Company: Lo ra nt A
City: Ao't'z Lce .Zz zG State: _/2
Address: r ee i'1 /
Zip Code: Jlf(?6 Fax:
City: F_U 2i St . C UCS e- State:
Phone No. 94 900
Zip Code: 0_+g5:L_ Fax: 77'2. J35 -t914
E -Mail:
Phone No. 17111 3 :3 S - v
Fill in fee simple Title Holder on next page ( if different
E -Mail: C u s t a i r
from the Owner listed above)
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPNLEMENIALCONS IRUC IIUN LIEN LAW INFURiVIAIIUN:
DESIGNERJENGINEER: Not Applicable
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: I
Address:
Address:
City:
City:
Zip: Phone:
up: Phone:
I certify that no work or installation commenced prior to the issuance of a permit-
ermitSt_
St-Lucie Counhimakes no representation that is granting a permit will authorize the permit liolder to build the subject structure
v:hicli is in conflict with any applicable Home O.. P.ers Association rules, b��laws or ano covenants that may restrict or prohibit such
structure. Please consult .with your HmOwnersoe Owners Association and revie.v your deed for any restrictions whicii may apply -
In consideration of the granting of this requested permit, l do hereby agree that I will, in all respects, perform the work
in accordance rgth the approved plans, the Florida Building Codes and St- Luce County Amendments.
The folioar.+ing building permit applications are exemptfrom undergoing a full concurrency review_ room additions,
accessory structures, si ornining pools, fences, Lta`Is, signs, screen rooms and accessory uses to another non-residentiai 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 recording your Notice of Commencement.
Signature of CEiner %_esseejContraCor as Agent for O:.vner !
Signature of Contractor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF ) '! _
COUNTY OF
t
The forgoing instunTent was acknowledged before me
The forgoing instrument was acknowledged before me
this /I/ day of /11, tA'— 20 Ly by ►
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I
thisu day of /2j�j� , 20 by
-
{Name of person ackro:+ledging)
(Name of person acknowledging)
(Signature of Notzry Public- State o, r.cr, _ia )
I (Signature of Notary Public -state GI =1onc=
Personally Known OR Produced Identificationn
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Personalty Kncn.m OR Produced Identification
Type of Identification Produced
Type o; Identification Produced
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Commission No- _ - CMSTINEBENROffiniission
No_
FG 052M
MY COMMISSIONS
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REVIEW
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INITIALS