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Building Permit Application
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Date Permit Number,.. CJ "00 Building Permit Application Planning and Development5ervices 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 PROPOSED 11VIPROVEMEiVT..LOCATION y' Address: `t�4�"=t, �b le_ �_ W.. _F�-. �' ze 3 4 l# _.._ �t cy Legal Description:,t• ����SI[�P .:1't4�" ;(�O. I. �,PG 55r1.a� �E ' . l 4 Property Tax 1D#: , (7(�(7 a _ Lot No— Site Plan Name. �R VQZQL�G2. Block.Na... . Project Name... 1� �-.. V024,i7CZ Setbacks Front Back: Right Side: Left Side: ©ETA ILEB'ICSClPTICit OF V1/C7RIC<' w �. L 14 f�vc �-,c Lo+t, ( (,'�f x lo'+v &U b(e , a11d. In T c '#'M pv e 4en et le�►`�t t 4`►��t Ott w c� • COIVSTRIlGTIQ 77-7771 IV INFORMATION `S itiona •rotor fio e e orme un er t 4s perrn�t c e¢. a app y QHVAC 'GasTank Gas Piping- Sh utters ,Windows/Doors Electric l_LPlumbingSprinklers Generator. ,;Roof Roof.pitch , Total Sq.Ft of Construction. 5 Ft of First door _. Cost of Construction:$ � Utilities Sewer Septic Building Height: OWNERJLHSEE: CQNTRACTC?ft. K vIJ- Name �� Q Name: . i1 Address: 114,44 6W is�M Company. y t E e. - State: Cit . .-. }`� '�, Address:;4�+"t�: S 9rA.srcae•, Zip Coders City..QY State, Phone No: t�. �-�oZ-33_ Zip Code:3'Z �' E-Mail Phone No S x. g( - Fill in fee simple Title Holder on next page(if different E-Mail: from the Owner listed above) State or County License, t 3Z L If value of construction is$2500 or more,a RECORDED Notice of Commencement is required. L F .._.. -. Rp DESIGNER/ENGINEER: licaiile LAW pP MORTGAGE COMPANY: _Not Applicable- " Name: Name 'Address: Address City State ww City: . tafie Zip - Ph Zip:_ Prone FEE SIMPLE TITLE HOLDER Not App(icabfe N8ONDING COMPANY Not Applicable. Name. — plicable Address.: _. Adtlressh city ;; Zip - Phone __- Zip OWNER/.CONTRACTOR AFFIDVIt•A lication is hereb pp y made to obtain a permit to do the:work and installation as indicated: I certify that no work or installation has commenced prior to.the issuance of a permit. St i ucie Cotinf#:makes n�?reprusentatri3n tEtat is granting a permit will authorize the ermrkihotderd boric#tkre subject structure ti rhtch is In-con Ict with any;a piidablc Horne;LW ncrs ArsscstJgtron rule ;;tsylaws or art ce ertants th t may restnet r.pibhibit such, structure P1?ase:consult rith,yaciF E(orne., W e€sftssoetatron'and reyReW,your:deed fr�rany restrrct csn�`which may pply In consideration of the g"ranting of this requested permit>I do hereby agree.that twill,in all respects,perform the work in accordance uwith 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 of Notice of Commencement may result in Y your-paying tgvice for improvements to your prgperty,..A Notice of Commencement must be recorded and posted on thejobsite before the:first inspection. if you intend to obtain financing,consult with lender or an attorney before comf.n ncitt ;work or recording.V rNotice of Commencement. " _._.. lip 5inatute:of,: rnerl Lessee/CgdttrcEor ast:for owner Sigtia of Citih a"ctor%LacenseHut er STATE•OF'T iJ STATE OF FLOP D A COUNTY OF e- COUNTY OF fi:.. LU C The;, r Ding instr en s akr�nUcrledgecE Beare>me The fgpin;irtsttutne twas acknptivle€iged before me i this. dat of k?�f 20 tip this: flda}�of 2Q tad by i dd Name'of person makipt�statement Name:of rerson m rng statement Personally'Known OR Produced Identification Personally Known RTroduced Identification Type of Identification 'Type of identification Produced s r'�ttt � 1i Produced ,s= (Signature of Notary;} rc .0 E 5rid#P)DkE'N8}�t7T r dkbfe of Notary Public Sta w AfdIiREWSA to , s, MYGO1uiF�fl5StC3N#fi32 Commission No. Na �$t 023., itimission No. �s UIMiSS ON#0 S4 0M Bonded Thru Notary Pabtic liniienirtil� 0 S. 4, �raNfGogedThnRNotaryPubic �Nr14trs REVIEWS FRONT ZONING SUPERV150R PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW LATE. - ,RECEIVED DATE COMPLETED _„ _. ;-. "Rev:8�2��.�`,.-".- ,