HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO
pMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �' 1,3 % Permit Number:
PR n -
ouiming rermn Hppilicavon
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
FERMI I APPLICA I ION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENI LUCAIION:
Address:
Legal Description:
Property Tax ID #: c��o� / " �� a "Op� �Q - Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DE I AILED UESCRIP I ION OF WORK:
4 9i LM <- Z S l I' S eq- CptkilSe rJV_r
L 11f e- 1
CONSTR CTION INFORMATION:
Addifio workto-6e er�ormed under tT�is permit= cTie� ckapply: -
VAC Gas Tank []Gas Piping Shutters E]Windows/Doors
Electric Plumbing Sprinklers [:] Generator Roof Rcof pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 3 Utilities: 11 Sewer aSeptic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Name: CUtcTI S 'S-A4k0Ac0
Address: <_Jr17 PICLCk-1 Company: C IoTa n1 A % r L, 5 t emI (k' c- '
City: State Address: l 5 S tia-C(r ee I1 r'
Zip Code. a's 7 Fax: City: �c% T S t Lucie_ State: r�-
Phone No. �lD�-' lD �S c3� Zip Code: y'f45Z - Fax: 77.; - 3 5-i 9 � 6
E-Mail: Phone No. i 11 3 3 S -2 3 -)
Fill in fee simple Title Holder on next page ( if different E-Mail: C u S t & I r S ti s Cc <<
from the Owner listed above) State or County License: C 0 51 E l Cl
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMEN IAL CONS I RUC IION LIEN LAND iNi-ORMAI IUN.
DESIGNER/ENGINEER. — Not Applicable ! MORTGAGE COMPANY -
Name: !—Not Applicable
Name:
Address:
Address:
City: State: City: State:
Zip: Phone: ; Zip: Phone:
i
FEE SIMPLE TITLE HOLDER: — Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address: j
City.
City:
Zip: Phone:
`up: Pirrone:
I certify that no work or installailoil ilas commenced prior to tile issuance of a pernl L
SL Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
v.-hich is in conflict with any applicable Home O.vrers Association rules, bv.lal.s
orand covenants that may restrict or prohibit such
structure_ Please consult _1idh your Home Owners Association and reviewyour deed for any restrictions which may apply_
In consideration of the granting of this requested permit, I do hereby agree that I .will, in all respects, perform the v ork
in accordance with the approved plans,' he Florida Building Codes and SL Lucie County Amendments.
The folloaing building permit zpalications are exemptfrom undergoing a full concurrency review: room additions,
accessory structures, sevimrning pools, fences, tvalls, signs, screen rooms and accessoR, 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, consult with lender or an attorney before
commencing work or recording your Notice of Commencement.
5
Signature of OErrler/-essee;'Contraciar zs Agertler O:.,ner J
Signature of Contmc:orlLicense Holder
STATE OF FLORIDA I
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STATE OF FLORIDA
_
COUNTY OF
COUNTY OF
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The forgoing instrut ert ;.ias acknowledged efore n� �
this day oc 911 (%j �� j
The forgoing instrun ent was acknouSedoZQ before me '
this 615
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I
i
22— day of 20 Z'�by
(Name of person ackrm.ledging )
(Name of person acknoxviedging )
(Signature of Notary Public- State of Fic ,da )
(Signature of Notary Public State
Personally Kno.t+n OR Produced Identification
Personally Kno:vn OR Produced Identification
Type of Identification Produced
Type of Identification Produced
Commission No_ - `�g Yv�y
_
CoCHRISiiNEBElYNo._
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EXPIRES: April6,M21
REl'IRAJ S
FRONT ZONING SUPERVISOR i PLANS ` VEGETATION
SEA TURTLE
MANGROVE
COUNTER = REVIE':N REVIEVVI REVIEW REVIEW
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REVIE1h`
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INITIALS
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