HomeMy WebLinkAboutBuilding PermitALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �^ �w ^ Permit Number:
a
ouilming rermn Applucavon
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 I APPLICA I ION FOR: To Select from dropbox, click arrow at the end of line I
PROPOSED IMPROVEMEN I LOCA I ION:
Address: J 71� C'
Legal Description:
Property Tax ID #: 303Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
llE1AlLED DESCRIPTION OF WORK:
/Ite r `A dY'Sl"( C.�J���� 43�� `fir`}✓
CONSTRUCTION INFORMATION:
Addition I-ivor 0 6e --formed urider_fiis permrt—c ec a apply - - - ------ — — - --
VAC Gas Tank ❑Gas Piping _ Shutters Q Windows/Doors
Electric F]Plumbing Sprinklers E]Generator 0 Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ _ ' �%- Utilities: Sewer aSeptic Building Height:
OWNERAESSEE: CONTRACTOR:
Name i
Name: GUl'f??[ S ,SAr4tyAon5
Address: r' Com pang: Ct l 3 TO m A , r- S t, s errs, n; r_ I
city: C>State:�C� Address: 11?15 E Vi t1 ag� ! (reern 0 r"
Zip Coder Fax: City: f O R-T 9t . L uc(c_ State: r%—
Phone No. � (_( Zip Code: a+g59.- Fax 77d 35-19 r, j
E-Mail: Phone No. '7 `I 3, 33 5 - 3 3- 31
i
RII In fee simple Title Holder on next page if different E-Mail: u S t & I r s y s y ao (. "-VM
from the Owner listed above) State or County License: /} co 5 ( 8 l 0
i
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMEN IAL CONS I RUCIION LIEN LAW INFORMAI ION:
Not
Name:
Address:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: _
Address:
City: _
Zip:
Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: S Late :
Zip: Phone:
BONDING COMPANY: _Not Applicable
Name:
Address:
City
ZP= Phone:
i certify that no work or installation has 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
which is in conflict with any applicable Home Owners 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 swill, in all respects, perform the work
in accordance Mth the approved plans, the Florida Building Codes and St. Lucie County. Amendments.
The folior+ing building permit applications are exempt from undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, sign-- screen rooms and accessory uses to another non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
improvementsto your property. A Notice of Commencement must be recorded and posted on the iobsite
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.
5
Signature of Owner/Lessee/Contractor as Agent for Owner , Signature of Contractor/license Holder
STATE OF FLORIDA ; I STATE OF FLORIDA
COUNTY OF_ S ' �. ; ' 1 COUNTY OF
The forgoing instrument mias acknowledgedl �efore me The forgoing instrument was acknowledged before me
this � day of ) /U 20 tbt: this day of _ '''I by
I
(Name of person ackno fledging) (Name of person acknowledging )
(Signature of Notary Public- State of Porida )
Personally Known OR Produced Identification
Type of Identification Produced
Commission No. - _ �4 CNRISi1NE813
Rei-ised 0:/15i3014
r
(Signature of Notary Public -State of Jlonc ;t
Personally Known OR Produced Identification
Type of identification Produced
emission No. -
Gomm g
9M1&d719u NdKy9wiom
M' iONfca
5 � E SAmne -Am
REViEWS
1
FRONT ZONING SUPERVISOR 1 PLANS ' VEGETATION
SEA TURTLE
idEANGROVE
COUNTER = REVIEW REVIEW i REVIEW RE4'IEVc!
REVIEW
REVIEW
DATE
COMPLE T E
i
INITIALS