HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFOMUSTBE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: —� 4 Permit Number:
DECEIVED
Building Permit Application
Planning and Development Services J U L 16 2 0 1 9
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 sT. Lu County, Permitting .
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION_FOR: To Select from dropbox, click arrow at the end of liney�
PROPOSED IMPROVEMENT LOCATION
Address: Co dc Le'-
LepA Description: 2awlC( - ✓�✓
C
F
CG S v G t w
Property Tax 1D#: — 140
Site Plan Name: eJ ! C-11-IP Block No.
-Project Name:
Setbacks Front Back: Right Side:: Left Side:
DETAILED DESCRIPTION OF WORK
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�C_ c s. R-i f d
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CONSTRUCTION INFORMATION:
AdditionalworK to bR nerrormed under tis permit-c ec all t=app y:
0HVAC Gas Tank E]Gas Piping _Shutters Q Windows/Doors
Electric Plumbing E]Sprinkiers Generator Roof
Total Sq.Ft of Construction:. Sq.Ft.of First Floor.
Cost of Construction:$ �. /d Utilities: Sewer Septic Building Height:
OWNER/LESSEE CONTRACTOR
Name & <' -l�7-ti-h�f h. 5•• &,y/fell Seh_ Name: c¢ C
Address: CG lC d/ f Company: r C S&!/-
City. c State:_ Address: C ha
Zip C_ de: 3 VIF57% Fax: / City: F f f cv� stage`` s
Phone No. J / ��� -�? Zip Code:3 W 6,>- - Fax:
E-Mail: �1� Phone No. 7 7 -- !—D LIP-
Fill in feesimple Title Holder on next page[if different E-Mail:
from the Owner listed above) State or Coun license:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
DE.SIGNE ENGINEER: Not Applicable MORTGAGE COMPANY: Nat Applicable
Name: Name:
Address: Address:
City.! State:T_ 0W. State:
Trp: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER:- " _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address: '
•
Zip: Phone: Zip: Phone:
I certify that no ixork or installation has commenced prior to the issuance of a permit
St Lurie Cou makes no rep �gtion that is granting a permiersAst authorize the permit holder to build the subject structure
�ctureconflict ow ny a your Home Owners o�nn and reviewy�d�nfforraanyyr restrictions which�applly. such
In consideration of the granting of this requested permit,I do herebMree that I will,in all respects,perform the work
in accordance with the appy plans,the Florida Building Codes and St Lade County Amendments.
The fbilowing'buitding permit applications are exempt from undergoing a full wncurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,scremroonand accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in yorur+►aying 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
comm"driff work or recordinst Your Nonce of Commencement
rmfiire of Owner/Agent/Lmsee Signature of Contractoi/Lreense Holder
STATE OF FLORI . `,S " R. STATE OF FLORIDA
COUNTY OF COUNTY OF S
The
tT%ay Y"-was adartourire methis �inhume of �S 'was acknowlefted me
20M by
�� "fit�..{' � y � 'Q�''cy t�cr C a c �•e.f -
(Mme of person admowlimWng) (Name of Perm admawledging)
(Slgnature of Notary -State of Florida} °`.;4� (5 nature of Notary Pu Ill Stere of Rdrida)
Personally Known OR Producedtd off„ Personally Known W OR Producedd
Type of tderifflcati;n Produced �� tiQ��e� Type of Identrfication Produced R� ��°�,,
Commission NQ.Cs �fi�"' -' 4� Q�e Commission Na 66 1W
Revised 07/15/2014s
�•TAZE O�c
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUM'ER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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