HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: y-� "l %
Permit Number:
gigs
nuiming rermlt Hppticavon
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
/
Phone: (772) 402-1553 Fax: (772) 462-1578 Commercial
Residential
PEKMI I APPLI(:A I IUN FOR: To Select from dropbox, click arrow at the end of line
NRUI'USEU IMI'KUVtMEN I LOCAI ION:_
Address: 99 /"E L�' Z'
-
Legal Descr,ptior,:
Property Tax ID ##: 3� %� f%D _ D/Od ODy " `7
Lot No.
Site Plan Name:
Block No.
Project Name:
Setbacks Front Back: Right Side:
Left Side:
UE I AILtU DESCRIP I ION Ui- WORK:
i
/
h� 21w �5�`f C,lA n5� DJC S `L �✓
�tqONSTRUCCTION INFORMATION:
HVa wor to oe a orme under this permit —check
a apply:
LlWindowsJDoors
AC Gas Tank []Gas Piping
_Shutters
Electric Plumbing Sprinklers
Generator 17 Roof Roof pitch
Tota; Sq. Ft of Construction: Sq. Ft. of First Floor:
[]Sewer F
COSI Of CORSCTUCtIOn: _ Utilities:
Septic Building Height:
–
OWNER/LESSEE: - - —
CONTRACTOR:
Name oSO�ui1-
Name: i; 1"P -T l S 51;akonC n
Address: ,�.?a L'(%irrelm�h
Company: Cus76rK A ,r- suS�e�kS
City: State: AIX
Address: 1 %t 5 1;�� t ( dG
Zip Code: 3A/ Fax:
City CPO 'r ,St • L State: r� j
Phone No. 77?
Zip Code: 3 +17 Fax: 71Q. J 357-1 9
E -Mail:
Phone No. Tl a- 3 3:5-
SFill
F1 I I in fee simple Title Holder on next page ( if different
E -Mail: C u s t a I cc o f c a t' t
from the Owner listed above)
I_
I State or County License:
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMEN IALCUNS I RUC IION LIEN LAND INFORIVIAI ION:
DESIGNER/ENGINEER: _ 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 I
Name:
Name: I
Address:
Address:
i
City:
City:
Zip: Phone:
up: Phone:
I certify that no work or installation commenced prior to the issuance of a permit_
St_ Lucie County makesno representation tlsat is granting a permit will authorize the permit holder to build the subject structure
v:hich is in conflict with any applicable Home O,vrers Association rules, by-laws or ann covenants that may restrict or prohibit such
structure. Please consult :•nth your Home O�mers Association and rev"e%v your deed for any restrictions which may apply -
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance e.ith the approved plans, the Florida Building Codes and St_ Lude County Amendments.
The follmknng building permit aapGcations are ewemptfrom undergoing a full concurrency review: room additions,
accessory structures, stornining pools, fences, .nails, signs, screen rooms and accessoR, uses to another non-residential use
WARN ING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice fo r
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.
O:.rler Sirof Contracor/License Holder
slanature Gf Ownerf-esseejContrac1tor as Ager-itfor nature
STATE OF FLORIDA i STATE OF FLORIDA
COUNTY OF ) '; ! COUNTY OF -
I
The forgoing instrument was acknowledged before rrre The forgoing instrument was acknovAedged before n,e
this day of 20 Eby I this day of ZO ,. by
I
i
r ackrc::Ied ins ' (Name of person acknov, ledging )
Nae or person
lm J 1
� _
v ✓ � ..-moi I - - / 'J' 1
�
(Signature of Notary Public- State c ricr;-ia) (Signature of Notary Public -State of rlorir I
Personally Kno.tn OR Produced Identification Personally Kriman OR Produced Identification
Type of Identification Produced Type of Identification Produced r
j ejvP4. CHRM'
CHRlSNIEBENf>pj�mission No.
Commission No`
?qa
MYCOMMISSION3I GOS2S46
EXPIRES- +Pra .2021 OSirPk i
o aan¢eaw�aerN,,ys.,,ns a BElVGi{--
— �cttbn MY COl4iMisstd�i # GG 1i52>43
Revised 07/15i2014 T? pwIRES:AW¢,Z21
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Bove
REVIEkAJS
FRONT ZONING SUPERVISOR i PLANS VEGETATION
SEA TURTLE
MANGROVE
COUNTER REVIEW REVIEW l REVIEW REVIEW
REVIEW
REVIEW j
DATE
COMPLETE
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INITIALS