HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 7'/6 " / Permit Number.
Irswicing rermll Hppillication
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-157S Commercial Residential
PEKMI I A}'PUCA I ION FOK: To Selma from dropbox, dick arrow at the end of line
YKUYt}5E0 IMPROVEMEN I LOCAL ION:
Address: li
Legal Description:
Property Tax ID ' /V /ZJ-tW'I GCS -1;7- Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back:
Lk I AILID DESCKI P l IUN UlF WOKK:
Right Side: Left Side:
/r~✓� �ILila_ row Sys«> ��f�Rsc our %�/ti✓
CONSTRUCTION* INFORMATION: _
Additional work o e rtorme under this permit - check ali app
❑HVAC 1 Gas Tank aGas Piping _ Shutters Q WindowsJDaors
11 Electric L_J Plumbing 11 Sprinklers � Generator � Roof Roof pitch
Total Sq. Ft of Construction: �f Sq. Ft. of First Floor:
Cost of Construction: $ _� S� / Utilities: Sewer LJ Septic Building Height
OWNER/LESSEE: CONTRACTOR:
Name /ire9i0-4z144Lam t7u.('d,d
Address: i �'O/ // Zw
City: 10;,te-State: �L
Zip Code: oyy,S_/ Fax:
Phone No. '46-0377 ,Qy10_10e7
E-Mail:
R11 in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: CUiCT1� �ArDtmcrS
Company: Li s-ro m A
Address: llcl5 E�ireen p
PC RT 9t . L ci state: r�-
Zip Code: Z4-q52.- Fax: `7r%?-
Phone No. �7'1 Z 3 3 S- 3 2 3 1-
E-Mail: �uStCl-lr Sys 4: Ccn� CGM
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of COMMeftcernent is required.
SUPPLEM EN I AL CONS I RUC: I I ON LIEN LAW 1 NF-ORMA I IUN:
DESIGNER/ENGINEER: _ Not Applicable
i MORTGAGE COMPANY: Not Applicable
Name:
j Name:
Address:
' address:
City: State:
City: State:
Lip: Phone:
i Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicab+e
Name:
game: I
Address:
Address:
City:
City -
Zip: Phone:
Zip: Phone:
I certify that no v.rork or installation has commented prior to tiie issuance of a perriit-
St- Lucie Countv makes no represent at=on that is granting a pem?itx:ilI authorize the permit holder to build the subject structure
v:hich is in conflict with any applicable Home Owners Association rules, bvlavvs or and covenants that may restrict or prohibit such
structure- Please con sutt .firth your Hone Owners Association and revie_•j ;your deed for any restrictions which may apply_
In consideration of the granting of this requested permit, I do hereby agree that I :vi}[, in all respects, perform the xrk
in accordance vAth the approved plans, the Florida Building Codes and St. Lude County Amendments.
The foltimt1ing building permit applications are exemptfrom undergoing a full concurrence review: room additions,
accesson; structures, sivirnmina pools, fences, vea'!s, 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 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
commencing work or recording your Notice of Commencement.
Signature of OE;nerl.essee}Contractor as Agent for 0,,A ner ' Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ` _ ! COUNTY OF -
I
The for oing instrument aas acknowledged before n:e ; The forgoing instrument was acknowledged before me
this !� day of ,%21,4 Y 20 I f by I this day of T� �}� , 20 by
(Name of person acknowledging) i (Name or person ac}mov:ledging )
(Signature of Notary Public- State of F cr"iz j ( (Signature of Notary Public- State o� lane:_
Personally Knotvn OR Produced Identif;cat;o=l Personally Known OR Produced Identification
Type of identification Produced I Type of Identification Produced
Commission No- t"i f^ ;.' i - - CNRI5T1hEBENt}j�mission i�o- �% c(�
2gga', _
* * MYCOMMISSIONS G052546W4
EXPIRES Ap-2021
0►}b 8 3anLepiieui�dgeiK5zry5evirrs ��..•••.4i�,-�l7RAYRVC$ENG(�li_:_..
Rex-ised 07 1 Si 2G 14 MY G0MWSSi0?1 j GG 032ak;
E)�lRES: AP4 a, 2021
RE.'IEXAJS
i
FRONT ZONING SUPERVISOR ( PLANS 'VEGETATION
SEA TURTLE
MANGROVE
COUNTER REVIEW j REVIEW 1 REVIEW REVIEW
� REVIEW
REVIEW
DATE
COMPLETE
INfTIALS------ -- --- -- 1 —------�
I
ISH
03m6
)21
UM100