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Home My WebLink AboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR.APPLICATION TO BE ACCEPTED Date: 3-Z9 Permit Number: r tsiui>taing vermix Appucavon 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 PEKMI I APPLIC:A I ION FOR: To Select from dropbox, click arrow at the end of line PROPOSED IMPROvEMEN I LOCAI IUN: Address: d/OS P,Q4 u gz4M",4 J d Legal Description: Property Tax lD##: ��a7'`1�,�^��Q'vli�✓� Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Sider 0L I AILED UESC91P I ION 01- WORK: ® i ee h C, P vt- O�G✓ G6� ,�•r Gllc� y�A1�S r C�� s CONSTRUCTIQN;INFO—RMATIQN: I a work o E E orme under t.is,permit—check a app HVAC �GasTank Das Piping _Shutters Windows/Doors Electric Plumbing []Sprinklers O Generator Roof Roof pitch Total Sq.Ft of Construction: __ Sq.Ft.of First Floor: Cost of Construction: ,yzS'� Utilities:[]Sewerraeptic Building Height: OWNER/LESSEE: --- CONTRACTOR: F Name +z MdAzlC �`' Name: G U tFT( S ,YA a'l OAC n S. Address: aE_ Company: Lt S"fo nt A ,r City: /-Alf, State: 1G Address:_I&I S S E VA i l Zip Code: �Jq Fax: (D PLT .St. L uci t State: r— Phone No. 77d d4l� 95 8 Zip Code: Fax 77.1• 3 S-��( � E-Mail: Phone No. Tl Z 3 3:5- - 3 2 3 2 Fill in fee simple Title Holder on next page(If different E-Mail: C et s t cx i r s ti s a 0 •(c'm from the Owner listed above) State or County License: CG G C' 51 1F 10 if value of construction is$2500 or more,a RECORDED Notice of Commencement is required. SUPPLEII EN IALC:ONS I RUCHON LIEN LAW INF-URMAHOW.- f DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable Name: Name: Address: Address: City: State: City: State: Zip: Phone: Zip: Phone: FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable Name: Name: Address: Address: I City: City: 1 Zip: Phone: Zip: Phone: I certify that no^work or instzllatioa,has commenced priorto the issuance of a permit St.Lucie Countv makes no representation that is granting a permit r:111 authorize the permit holder to build the subject structure a:hick is in conflict pith any applicable Home Owners Associationrules,bylativs orand covenants that may restrict or prohibit such structure.Please consult Ath your Home ownersAssociation and revievaj your deed forany restrictions which may apply. Inconsideration of the granting of this requested.permit,I do hereby agree that I will,in all respects,perform the v ork in accordance i Kith the approved pians,the Florida.Building Codes and St Lude County Amendments. Thefiulloveing building permit applications are exemptfrom undergoing a full concurrency review:room additions, accessory structures,stitdmming pools;fences,wralls,signs,screen rooms and accessory uses to anothernon-residential use WARN IN 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 lobsite before the first inspection-If you intend to obtain financing,consultc+vith lender or an attorney before commencing work or recording your Notice of Commencement. Signature of,Ov+ner/Lessee/Contractor as Agent f 0 Ormer Sib ature of Contrador/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF . �a '� f . r'.l t' COUNTY OF = Z The forgoing instrument-irAscknowledged before me The forgoing instrrmtent wvas acknotiviedged before me this , r�day of i044:o4 . 20 /fir this qday of � �� ,20 by (Name of person ackno..rledging} (fume of person acknowledging)~ (Signature of Notary Public-State of F-' 'da) (Signature of Nota[y Public-State of Flori�{ Personally Krimun OR Produced Identification Personalty Knotvn ` OR Produced identification -type of ldenti[e©tion'Produced Type of Identification Produced- { A00 P4, cmr_ ISH a° Commission No. r''Ul L'f�j ? f'c^ v N B�nCCesRTteSuIwMB•_rHsxe7ay5ef,r6rCmis-sion No.t7f�, ttia':�.l..D4) y iz WCOMM80N3IGo56 221 2 e1 EXPIRES:w ry k:l�S Revised 0:115i301 a�rp4 so2t RE1,r1Eln1S FRONT : ZONING SUPERVISOR PLANS i VEGET 11ION _SEA TURTLE MANGROVE- COUNTER REVIEW REVIEW REVIEW ! REVIEW REVIEW REVIEW I DATE g COMPLETE t INITIALS f 1 t !