HomeMy WebLinkAboutBuilding Permit Application Aj
FIN,
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Iq Permit Number: i4-DO
,0
S,
4
Building Permit Application �_Vz
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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PC �Y
Address: ((Oct RusS,s kook
Legal Description: C6n_,ZCLZM ,'Ck
Property Tax ID#:3L103-503 -6346-000-F Lot No.
Site Plan Name: Block No.
Project Name:) SCLC ,.. (NCtrC
Setbacks Front Back: Right Side: Left Side:
MN n
QW CA- L e-
CONSTFUCTtON Y
N-� R.W.N
__jA
Additional work to be performed under this permit—checK all Inal apply:
1]HVAC Gas Tank []Gas Piping Shutters z Winclows/Doors-
FlElectric 0 Plumbing 11Sprinklers Generator 13 Roof
Total Sq. Ft of Construction: 5Q. Ft.of First Floor:
Cost of Construction:$ Utilities: �Sewer F1 Septic Building Height:
0 7
T-0
_R
Name r_,,C- iacx,y
Address: is<3 4i lus-s L"elell-_ Company: C
City: 41 c L e ce State:Fi Address: t 3 (g 1 -75 Ti-I C A-;
Zip Code:.? J?Q, Fax: City: c-
,(, State:
Zip Code:_3'_' q I Q Fax: 51-1
Phone No. V)0L-3Z2_qL40Y
E-Mail:
Phone No._-5bi- 2
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License: C (,c-, C,o'
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
r`P
lV! §3 SARUMAO LIE1 AtN INF�RMATiQN k -
u �.{sry� .:cam
'- - 'F': ..+mss r.'�- L µ4- 2s„•r, _ x�',r's., r'�v r .. -,.r t x f L '"" I
r-
5.ft....:.. .•.->:4:.n1•r�`h�.$,;�"3'„> 4�. � L .k_..s,�� T..�. _
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TiTLE HOLDER: Not Applicable BONDING COMPANY: _Nat Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: 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 prohibif'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 will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,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
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 our Notice of Commencement.
_Signature o wner/Lessee/Agent Ignature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA r
COUNTY OF S tJCt COUNTY OF /(. ��1�'t t C6
The forgoing instrument was acknowledged before me The fo oing instrument was acknowledged before me
this 21 1.�G day of � 20 aby this day of 20 by
r, Q w e t)a
(Name of person acknowledging) (Name of person acknowledging)
f
( ' nature of Notary Public-State of Florida) (Signatu of Nota Public-Sta of Florida)
Personally Know R P Personally Known OR Produced identification
Type o entification Pr u Type of Identification Produced
MY COM 1SSj�N#GG8b042
OF V.
PUBS% ANGEtAYQUNG
Commission No. � B7{Prch27,2021 Commission Na._ -, My6SIONkFF951069
N' a EXPIRES:April 12.420
4FUdoefNota Services
Revised 07/1S/2014
i,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
3
INITIALS