HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 7/'�' y -/ c Permit Number:
ounaing YePTTiiT Appillcavon
Planning and Development Services
Building and Code Regulation Division /
2300 Virginia Avenue, Fort Pierce FL 345132
Phone: (772) 402-1553 Fax: (772) 40'2-1578 Commercial Residential
PERM I APPUCA I ION FUR: To Select from dropbox, click arrow at the end of line
PROPOSED iMPKU_VEMI_N I LOCAI ION: --
Address:
Legal Descriptor,:
Property Tax ID l: 3 �� S `a �,! .SCC .1
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Ut I AILED DE5CKIP i ION UI. WORK:
t, L 1 k t-- Z -) ° n / yS-ec ( C4A nSt Ot ��1 A✓
CONSTRUCTION INFORMATION:
t a WorK to e e rme un er t ,is perm i# – c
HVAC L Gas Tank Gas Piping
ElElectric LJ Plumbing Sprinklers
Tota: Sq. Ft of Construction:
Cost of Construction: $ 36"Q' —
OWNER/LESSEE:
Lot No.
Block No.
1Shutters []WindowslDoors
[] Generator 7 Roof Q Roof pitch
Sq. Ft. of First Floor:
Utilities: 7— Sewer E Septic
Address: 7fEy 140 CI n tock G✓ay
F
City: l�cR r �r L� C/ -L State:
Zip Code: s4zf.5'12- Fax:
Phone No. 7, -1,2 d%73 /zI!7
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Building Height:
Name: CUt4Zl� �rL(�v1cnS
Company: �(CS?int ���r SuSestilS t>Lc,
P
Address: l lY l 5 S E1;1; 1 i dG 1J t ee i1
�n -r SL . ! u c i 'e—' State:—f
j
Tip Code: Fac
7L2- '35-ici
1 Phone No.
E -Mail: L i st xi 5T Qo1 CC.rrt
State or County License: F l C'
ff value of construction is $2500 or more, a RECORDED NObce of Commencernent is required.
SUPPLEMEN IAL C:UNS I RUC I[ON LIEN LAW iNFURMAI IUN:
DESIGNER/ENGINEER: _ Not Applicable
; MORTGAGE COMPANY: — Not Applicable
Name:
j Name:
Address:
' address:
City: State:
City: State:
Zip: Phone:
i Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address: 1
City:
Cityr
Zip: Phone:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a perrnit.
St- Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any applicable tome Owners Association rules, by. lairs or ana covenants that may restrict or prohibit such
structure_ Please consult :•firth your Home Owners Association and revile v your deed for any restrictions vihich 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 i.Ath `the approved plans, the Florida Building Codes and St_ Lude County Amendments.
The follor.�ing building permit appGcat_ons are exemptfrom undergoing a full concurrency review_ room additions,
accessory structures, stuimming pools, fences, signs, screen rooms and accessory uses to another non-residentiai use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice Tor
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 ovi.ler/_essee!Contracior as Agentfer O.vner I
Sio ature of Contracor/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF _ - i
I
COUNTY OF =�•
The forgoing instrument was acknowledged before me �
The forgoing instrument Luis acknowledged before me
this d 9 day of �9 by I
this d 9 day of20 /9 by
(Name of person acknowledging j
(Name of person acknowledging)
(Signature of Notary Public- State o< F er,da j I
(Signature of Notary Public- State of lorit.g-,
Personally Knot-Lm OR Produced identification
Personally Known OR Produced Identification
Type of Identification Produced
Type of Identification Produced
°� CHRISTINEBEN0Mffimission
r S)o P4, Cpj �m s.'t
Commission No_ _ q
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G02546
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