HomeMy WebLinkAboutBuilding Permit applicationI -APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO RE ACCEPTED
,,,9._ Permit Number:
Date:
_i_D_
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34992
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address:
Legal Description: 2 FS
Property Tax ID #: %J", "J `-' r `
CT+— 131— I\lnm=.
M
Project Name:
Setbacks Front Back: Right Side: Left Side:
Lot No. r0
Block No.
s
_Mechanical Gas Tank , Gas Piping _ Shutters ^ Windows/Doors
Electric Plumbing J Sprinklers _ Generator _ Roof Pitch
Total Sq. Ft of Construction:
Cost of Construction: $. �Z
Sq. Ft. of First Floor:
utilities: Sewer —Septic Building Height:
Name •.a Q-T" N r
Address: 1 9 i
City: r— State: EL
Zip Code: Fax;
Phone No.
E-Mail:
Fill in fee simple Title Holder on next page [ if different
from the Owner listed above)
Name: DC-Ar,i�J
Company: r~ C
Address: -
City: O
PKA-
Zip Code: 2
Phone No 9_Ir��—
E-Mail
State or County License C
p l�, State: F1
Fax: Tj�j7„ 54a_AN11z_
4j_64
if value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
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FIN
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DESIGNER/ENGINEER:
Not Applicable
MORTGAGE COMPANY:
Not Applicable
Name:
Name:
Address:
Address:
City:
State:
City_
State:
Zip: Phone
Zip: Phone:
FEE, SIMPLE TITLEHOLDER:
Nat Applicable
BONDING COMPANY"
Nat Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip-, Phone:
Zip. Phone-
_ si_
..I_ ...] :.. w-L..{Inti� rri r/"�'Oli
OWMER/ CONTRACTOR AFF€13VI € : Application is hereby made to ubt-tau u Pr- to uu i.uc —1 n au ra+ rr�.+.i+�..• •• � •• •-•--_,�_
I certify that no work or installation has commenced prior to the issuance of a permit
St Lucie Coun makes no representation that is granting a }permit will authorize the permft holderto build the subject structure
swhich is in tructure— Please consult withpyouCr Homeowners Associadon andrreview your+deed %a any arents sttri that
which m y apply.estrict orhi6itsuch
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
The #allowing building permit applications are exempt from undergoing a full concurrency review_ room additions,
accessary structures, swimming pools, fences, walls, signs, screen rooms and accessary uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Nonce of Commencement may result in your payingtwice 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 tender or an attorney before
commencing work or recording our Notice of Commencement
K % I K N 4. ( I
Signature o owner/ € essee/C itractor as Agent for Owner 5' re of Caritractarcense Holder
STATE OF FLOIDA STATE OF FLORIDA ,
COUNTY OF -4- QIN ► I/�r COUNTY OF End Qr•
The fRgolng instrument w s acknowledgep before me The f rgoing instrumentwas acknowle&r2A before me
this day of Zo 1 by this day of..J
Name of person making statement. Name of person making statement
Personally Known OR Produced identification Personally Known OR Produced Identfication
Type of identification Type of Identification
Produced, Produced
[Signature of N E_J21
(signature of11Pamela
Dyer-Hope MY
Pame!>w Dyer'l tape
Commission No ,>; Commission N22
a
REVIEWS FRONT ZONING SUPERVISOR PI-ANS rVEGETA11ON SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEWMF i REVlt�kl REIIEEW
DATE
RECEIVED
DATE
COMPLETED
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