HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: op -If `9 Permit Number:
owilaing eermn Hppucavon
Pianr;irg and Develaprnent Services
Building and Code .Recm'atior, Division
2300 Virginia Avenue, Fort Pierce Ft 34982
Phone: (772) 462-1553 Fax: (772) 462-=578 Commercial Residential
PEKMI I APPLICA I IUN FUR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENI LUCAIION:
Address: GG� 1Ar2
Legal Description:
Property Tax ID I: r7 _ Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
UE I AILED UESC:RIP I ION OF WORK:
/lle /1,e- -I : Seer 4 �fA Sc-
CONSTRUCTION INFORMATION:
Add ffi a wor to 6e er�ormec! -under this permit - t�iec a app y
�HVACGas Tank ❑Gas Piping _Shutters Windows/Doors
❑Electric Plumbing [:]Sprnklers Generator Roof Roof pitch
Tota Sq. Ft of Construction: Sq. Ft. of First Floor: /
Cost of Construction: $ ! 2) 0 C) Utilities: Sewer Septic Building Height:
OWNERAESSEE: t CONTRACTOR:
1 Name /I![' drvrac� a Name: C U� T i S ,SH rLl i.�� o r1
Address: PY63 A Company: CuI�TGM � �� Sc+S —
City: off.% ter' state: �L Address: l k't 5 Lit l (sec �t r cue i1 /
Zip Code: �— Fax: City: Co R-T St . L uc i State. �L j
Phone No. P7f "3YY iy Zip Code: a +1751- Fax: 7w J-3
r-Mail: ' Phone No. A l a 3 3 S-
Fill in fee simple Title Holder on next page ( if different E-Ma;l: C u St C= i r- 5 ti s £ Cc CA
from the Owner listed above) State or County License: Ct C C.' S ( F l C) — —3
if value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: !% _lP `9 Permit Number:
•
ouliming rermit Applic;avon
Planning and Development Services
Building and Code .Recuiaiion Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential `
NEKMi I APPLICA I IUN I -UK: To Select from dropbox. click arrow at the end of line !
YKUNU_SEUIMPRUVEMENI LUCAIIUN:
Address �A�
Legal Description:
Property Tax ID 1iv�`�` ^ 7D� �7V 1 Lot Nc.
Block No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
i
UE I AILED UESCKIP I IUN OF WUKK:
��S<<r D% n c. [CONSTRUCTION INFORMATION: _
AdTH
a vror to oe��med under this permit — c ec a app y:
AC 11 Gas Tank ❑Gas Piping Shutters F—I4Nindows/Doors
Electric LJ Pumbing Sprinklers Generator 10 Roof Roof pitch
Total. Sq. Ft of Construction: SgFt. of First Floor: n
Cost of Construction: $ 0,0 0 Utilities: Sewer Septic Building Height:
�OWNERAESSEE: (CONTRACTOR:
! Narrie�� dyvtt�� 4 Name: C. i' fc T (; ES rtlt.i�o 0
FVVIa l A- G
Address: 7�63 i— Cam piny: cl T6rtit r c� 5
1 i15� 1�; li�eG� C�rt'�it
City: State: L Address —T
Zip Code: Fax: I City:
cs 2T ,.St. L o c i State: r
Phone No. f %8 i`/ Zip Code: v `145Z Fax 77 j 3�-i 5 hQ I
E-Mail:
Phone No. ` 11 335-
- 323
Fill in fee simple Title Holder on next page if different E Maa: C u ° t s y s Q o b�oi
from the Owner listed above) State or County License: F l 0
, C n S (
If value of construction is $2 s00 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENIALCONS IRUC iION -'LIEN LAW iNFURiVIAIIUN:
DESiGNERf ENGINEER: Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
Name:
`Address:
j Address:
City: State:
Cite: State:
Zip: Phone:
i Zip: Phone:
i
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable I
Name:
Name:
Address:
Address:
i
ci-
City:
Zip: Phone:
up: Phone:
I certify that no vrork or installation ijas commenced prior to the issuance of a permit_
St_ Lucie Courtvmakes no representation that is granting a permits_ill authorize the permit holder to build the subject structure
v.hich is in conflict Leith any applicable Pome O.•rners Assocration rules, byla-u s or ana covenants that may restrict or prohibit such
structure- Please consult _4ith your Home 0--ners Association and revie,j'your deed for any restrictions vihich may apply-_
In consideration of the granting of this requested permit, I do hereby agree that i MR, in all respects, perform tie r_ork
in accordance •r,ith the approved plans, the Florida Building Codes and St_ Lucie County Amendments.
The follor.ling building pern-wit applications are exempt from undergoing a full concurrency recdesv: room; additions,
accessory structures, vmm ring pools, fences, .�ra`ls, signs, screen rooms and accessory, uses to another nor. -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, consu It «rith lender or an attorney before
commencing work or rece-ding your Notice or Commencement.
.
r traas Auent for Ov,ner ;
�ofOEJnerJC�nces
Sio;
Signature of ContractorJLicense Holder !
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF i
COUNTY OF
The forgoing instru 2rt _ras ackno. IedgedPefere me !
The forgoing instrument wasacknov,'sedged before n,e
20_ by
ibis_ day of C 2t7 /�b� 1
this ,� day of
(Name of person ackno pledging j
(Name of person aclmot:,l2dging )
(sinn
gnature of Notary Public -State oz, r`criria j
(Sis nature of Notary Public- State o =lori
Personalty Knoetim OR Produced Identification
Personally Krovin OR Produced Identification
Type of Identification Produced
f Type of identification Produced
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