HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
•
r�
ouij aing rermn iApp ication
Planning and Development Services
Building and Code Regulation Division
2-300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: f772) 462-1578 Commercial
1 RoPOSEU lMPKOVEMEN i LQLAI ION:
Address: - '-- % —Qro 6t-"6 e 'U/c
Legal Description:
Property Tax ID #: ,�`i/�% .SO/- LzT z ee2 _�,
Ste Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
UE I AILEU UESC:KIY I ION Ot- WOKK:
CONSTRUCTION INFORMATION:
Residential
Lot No.
Block No.
qna wo o f:]GaisTank
rme under this permit - cnecK ati apply.
HVAC []Gas Ptping _Shutters OWtndows%Doors
Electric 1 Plumbing Sprinklers []Generator 7 Roof
Total Sq. Ftof Construction: ,
Cost of Construction: $ `1 rY
OWNER/LESSEE:
Sq. Ft. of First
((Floor -
Utilities: Sewer ISeptic
Address:? Cro G,rLVY�� L)g!:(J
City: r'1 o R-r St A.kC i t State: FL
Zip Code: �{4502 Fax:
Phone No. 36-6o6-'7336
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
CONTRACTOR:
Building Height:
Roof pitch
Name: C U v9, A fLk;rP C ri
Company: L t s 7a rv- A r u s
Address: l lY t 5 i j; l 4 dG
f 07T .St . ! U C{ e—, State:
ZiP Code: w 4SZ- Fax: `7rla- ?.S-t � Ic e j
Phone No. `1 1 L 3 3 5-
E-Mail: C u r t i 5 ti s L Cc o f t wi_
State or County License:
I va tue of construction is $2500 or more, a RECORDW Notice of Commencernent is required.
SUPPLEMEN IALCONS I RUCIIQN LIEN LAW INI-UHMAI ION:
DESIGNER/ENGINEER: Not: Applicable
l MORTGAGE COMPANY: Not Applicable l
Name:
Name:
Address:
address:
City: State:
,City: State:
Zip: Phone:
{ Zip: Phone:
f ,
FEE SIMPLE TITLE HOLDER: — Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
Ciiy
City:
Zip: Phone:
Zip: Phone:
I certify that no work or installation :gas commenced prior to the issuance of a permit
St- Lucie County makes no representation that is granting a permit :ill authorize the permit holder to build the subject struk lure
which is in conflict with any appricable Home Ormers 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 permit, I do hereby agree that I tAl, in all respects, perform the work
in accordance vAth the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exen.ptfrom undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARN LNG 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 Vour Notice of Commencement. -
s
Signature of Oviner/_essee/ Contractor as Agent f er Crmier
Signature of Contractor/license Holder I
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument ,vas acknowledged before me
The forgoing instrument was acknom,edged before me
this to day of 06Ae- 20 l4 by.
I
this 10 day of oTONe 20 by
iii
(Name of person acknc..ledging j `
i
lZme of person acknolvled -no ) '
fP2 gr a
s
—
-
{Signature of Neiary Public- State or F cif-ia ?'
Sr iature of Notary Public -State o� Ion: _.
{ ray i
Personally Knottim DR Produced Identification
Personally Known OR Produced Identification
Type of Identification Produced
Type of Identification Produced
'40Q% WAIS?ul-i! rri
Commission No- '- ` _ _ - - _
nussion No. - -ON
*q`SB
Re«sed 07/15i2014 s
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