HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO pMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a3 l / Permit Number:
owlaing f'ermix f{ppicaxiofl
Planning and Development services
Building and Code Regulation Dvision
2300 Virginia Avenue, Fort Pierce FL 345182
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential ✓
PEKMI I APPLIC;A I ION K3K: To Select from dropbox, click arrow at the end of line
PROPOSED IMPKOVEMEN I LOCAI ION:
Address:
Legal Description:
Property Tax ID #: �S,2a - �oc� �'Q���-�QD Lot No.
Site Plan Name: Block No.
Project Name: _
Setbacks Front
Back: Right Side: Left Side:
DE l AILED DESC RIP I ION 01- WO KK:
,C 4 �, L ke, a rrler <Z Zr
CONSTRUCTION INFORMATION:
a lNo to oe rme under this permit - c ec a apply:
VAC aG11T as
Piping _ ShLtters Windows/Doors
t�EIectric 11 Plumbing Sprinklers Generator 17 Roof Roof pitch
Totai Sq. Ft of Construction:
Cost of Construction: $ ' 6 �d
OWNER/LESSEE:
Sq. Ft. of First] Floor: _
Utilities: 11 Sewer ! =.J Septic
Name Cla lie o I -Pam S /yai,4 Lo l uti
Address: is /d,�ECia12i'
City: State: /V/9
Zip Code: 170VFax:
Phone No. Sof - 7';�� -0 IM/ -
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
BLiiding Height
Name:Ct;r5_7Tr,tlko'cn;
Company: CttS-ronl A �- L4Stes'1'tS
Address: l 15 �l i l i dG �� r-ee a
City �O R -T Sz . ! c•c State: r -t -
Z p Code: u t4 52 - Fax
Phone No.
E -Mail: C g s t a f r- 5 Q o i C 6 rrc
State or County License: n j I
if value of construction is $2500 or more, a RECORDED Notice of Comrrrencement is required.
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SUPPLEMEN IALC ONS I RUt:IIUN LIEN LAW INFURIVIAI IUN:
DESIGNER/ENGINEER: _ Not Applicable
1 MORTGAGE COMPANY: _ Not Applicable
Name:
j Name:
Address:
address:
City: State:
City: State:
Zip: Phone:
1 Zip: Phone:
i
FEE SIMPLE TiTLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable i
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
Zip: Phone:
I certify that no .cork or installation ilas commenced prior to the issuance of a permit.
St_ i ucie County makes no representation that is granting a permit mill authorize the permit holder to build the subject structure
whi h is in conflict with any applicable Home O, niers Association rules, b:�laLvs or and covenants that may restrict or prohibit such
structure_ Please consult :vith your Home Oti•.ners 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 vAth the approved pians, the Florida Building Cedes and St_ tune County Amendments.
The folimkiing building permit applications are ezen-ptfrom undergoing a full concurrency review_ room additions,
accessory structures, ss.4mi-iing pools, fences, wa'Is, signs, screen rooms and accessory uses to another noir-residential use
WARNING 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 recerdingyour Notice of Commencement.
s
Signature of O4.ner/_essee;'Contractor as AcFentfor O.a:ner !
Sig—nature of Contractor,lLicense Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF I
COUNTY OF -
The forgoing instrument vias acknordedged before me
The forgoing instrument was acknoL%;ledged before me
this � d day of 20 19 by Ithis
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23 dal of �{J1� r C 20 l by
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!Name of person acknov.ledging j !
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;Name of person ackncy!ledging j i
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(Signature of Notary Public- State of r cn_ia j I
{Signature of Notary Public- Stateb! , lori4
Personalty Known OR Produced Identification
Pzrsonaliy Known OR Produced Identification
Type of Identification Produced
Type of identification Produced
Commission No_ _ - _ rq aP,'t� CHRISTiNERENr41}lmission
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EXPIRES: Mn7 4, 2021
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FRONT ZONING SUPERVISOR PLANS VEGETATION
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COUNTER REVIEW REVIEW REVIEW REVIEW
REVIEW
REVIEW
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INITIALS
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