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HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date: I/- f -d Permit Number: J`-,:_ oullioEng rermit Appica-Eivn 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 PRopuSEU IMP OVEMEN I LOCAI ION:_- Address: Legal Description,: Property Tax ID #: �T 2 S /Y67- 6)c7 S- ax— Lot No. Block No. Site Plan Name: Project Name: Setbacks Front Back: Right Side: Left Side: DE I AILEL) L)ESC:KIP I ION OI- WOKK: CONSTRUCTION INFORMATION: XVAC a war to e e rme un er t !s perm!t - c ec a appy: Gas Tank Das Piping _Shutters Windows/Doors 11 Electric U Plumbing Sprinklers []Generator F]Roof Roof pitch Totai Sq. Ft of Construction: r � Cost of Construction: $ �J OWNER/LESSEE: Sq. Ft. of First] Floor:_ Utilities: []Sewer Septic Name 1pn a Ja rLa 1Yhle rer7 vp w r i �, Address: City: �O0 T ST 4u(I'e State: �L Zip Code: L Fax: Phone No. r/ N - S 73 - 13 7'b E -Mail: Fill in fee simple Title Holder on next page ( if different from the Owner listed above) CONTRACTOR: Building Height: Name: CULT1S '5Aa oAC(7 Company: 5s45te%'!'l5 l"" - Address: 1 lr? t 5 Lel l (dG - �� �e i1 City: Fv 2T St . L u { State: Zip Code: 3+175'Z- Fax `i77 35-icI Phone No. -7,11 3 3 5- - 2 E -Mail: Cu stcilr Stis CcC CL✓M State or County License: If value of construction is $2500 or more, a RECORDED Notice of commencement is required. SUPPLEIVI EN I AL CUNS I RUC I ION LIEN LAVA I NFUhMA i ION: DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: Not Applicable Name: ;Name: Address: address: State: City: State: Zip: Phone: i Zip: Phone: i FEE SiMPLE TITLE HOLDER: _ Not Applicable ' BONDING COMPANY: Not Applicable Name: Name: j Address: Andress City City: Zip: Phone: up: Phone: ! certify that no work or installa6 Onh -s commenced prior to the issuance of a permit_ St- Lucie County_makes no representation that is granting a pe -'it will authorize the permit holder to build the subject structure Home Owners Assocratron rules, b��laws orana covenants that may restrict or prchibit sucn v:hich is in conflict. with any applicable structure. Please consult vAh your Horne O-o ners Association and reyie.v your deed for any restrictions which may apply. in consideration of the granting or this requested permit, I do hereby agree that I will, in all respects, perform the work in accordance with the approved pians, the Florida Building Cedes and St_ Lude County Amendments. Thefollor:ing building permit applications are exen:ptfronl undergoing a full concurrency review: room additions, accessory structures, s-mmming pool, fences, :!alts, signs, screen rooms and accessory uses to another noir-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 record ing you r Notice of Commencement. for Owner j Signature of ContractorfLicense Holder Signature of OE;ner/ esseei'Contracor as Agent (� STATE OF FLORIDA i STATE OF FLORIDA COUNTY OF '� r` i COUNTY OF 4 I The forgoing instrument was acknowledged before me The forgoing instrument .vas acknov:ledged before me I this day of �� by this ;J day of m _' b. T --- l l (Name of Gerson acknowledging) (Name of person aclmo.s ledging ) (Signature or Not--ry Public- Stet_ o. F.crkda j I (Sig])ature of Notary Public -State Of, !erica i I Personally Knobvn OR Produced Identification Personally Known OR ?roduced identification Type of Identirt©lien Produced Type o• Identification Produced ; o P4�cY14, �° CHRISNIEBENt4lfzmission No_ No- _ _ i Commission _� :q _ }MY COMMISSION 3 G 052546 --0{1 pPiRES Agr02021 RBENGl_i- Ale._— - pt zOkflSSi0NfGGM2a48 Revised 01 /1-:V2014 >�tl�s avr� a, zort REl'IE\�1S i I FRONT CONING SUPERVISOR PLANS = l ' VEGETATION SEA TU MANGROVE COUNTER REVIEW i REVIEW REVIEW REVIEW REVIEW j DATE ` COMPLE i E INITIALS