HomeMy WebLinkAboutBuilding PermitALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
;Nate: J'or!�- � � Permit Number:
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auiliaing rermit Hppiltcaluon
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 1 APPLICA i LUN FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPKU_Vt_ MEN i LOCA l ION:
Address: - --� �D S i' If, .S//-" 1 ;61 � / a N'
Legal Description,:
Property It ID #:
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ff4W 16 G
Lot No.
City:
pi.2i�� State:
Site Plan Name:
Phone No.
77�1, ` ro y
Block No.
Project Name:
Setbacks Front Back: Right Side:
UE l AILED UESC:K1P I ION OF WORK:
Left Side:
//c� ��� �,�zL Yin ��s�� C�AAS 0V
4CONSTRUCTION INFORMATION:
ai wor to be rme un er t pis permit — c ec a i app
�VAC Gas Tank E]GasPiping _Shutters L]Windows/Doors
Electric Plumbing OSprinklers li Generator It 7 Roof Roofpitch
Tota; Sq. Ft of Construction:
Cost of Construction: 7 fid 0 r
OWNER/LESSEE:
Sq. Ft. of First Floor: _
Utilities: 11Sewer F7Septic
Narrie %1U_a1M
Address: 3aX
J 7*�,h 01
City:
pi.2i�� State:
Zip Code: a— Fax:
Phone No.
77�1, ` ro y
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Building Height
Name: C U j�_'T ( S Jr- 4oAc n
Cam pany: C c t S -rc of As u 5eyvi s lit c�
Address: l lY L 5 Ll; 1 i dG S t �e iZ
City ffG Tr ,9t . L ; c t—, j State: r —
Z p Code: a+q sZ - Fax: '77,7- . 3 5- t c �-
Phone No. 171 Z 3 3:5- X 3 2
E -Mail: C 'l S t cz i t S ti s Q C, i C [art
State or County License: C? j l F
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
I
SUPPLEMENIAL CONS I RUCHON LIEN LAW INFURMAIION:
DESIGNER/ENGINEER: Not Applicable I
MORTGAGE COMPANY: Not Applicable
-� F
Name:
Name:
Address:
Address:
City: State:
, City: State:
Zip: Phone:
1 Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
Zip: Phone: ;
i
Zip: Phone:
I certify that no work or installation :las commenced prior to the issuance of a permit_
St- Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
v:hich is in conflict with any applicable Home Osmers Association rules, bylaws or and covenants that may restrict or prohibit such
structure_ Please consult with your Home Owners Association and review your deed for any restrictions Which may apply.
In consideration of the granting of this requested pernu-t, I do hereby agree that I will, in all respects, perform tie work
in accordance vzth the approved pians, the Florida Building Codes and St_ Lucie County Amendments_
The follor, ing building permit applications are examptfrom undergoing a full concurrency review: room additions,
accessory, structures, swimrvng pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARN ING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice zo r
improvements to your property_ A Notice of Commencement must be recorded and posted on the }obsite
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. -
s
Signature of OEa'ner/_essee;Contractor as Agentfor O:arner !� Signature of Contracor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF _ COUNTY OF =
i
The forgoing instrument was acknowledged before me The forgoing instrumentwas ackrim ledged before n:e
this " a day of M y 2� by the a qday of y1t l4 y , 20 by
i
-_. (Name of person acknocsledging ;I
(Name or person acknc.ltedging j � ?
(Signature of Notary Public -State of F[c cia j (Signature of Notary Public- State of : icri- t
Personally Knmvn OR Produced identification Personally Known 0-4 Produced Identification
Type of Identification Produced Type of Identification Produced :
Cf!rtt�"a:.t =ori
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Commission No_ cHR1S7M8 mission No_ _ : -
Ap1.2021 rgYyy�u��vev `
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Revised 07/1-1201-# D ES`.Aprii4,2MI
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RR,IIEWS FRONT ZONING SUPERVISOR I PLANS ' VEGi_T'A; iON SEA TURTLE iV1ANGROV. E
COUNTER REVIEW REVIEW' l REVIEW i REb'IEW REVIEW REVIEW
DATE
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COMPLETE
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INITIALS
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