HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: /10.
Building Permit Application �� I�®
Planning and Development Services �Q
Building and Code Regulation Division AfAY a,
2300 Virginia Avenue, Fort Pierce FL 34982 Zo" `
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial ResidentApl,°� g �,�*�t
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line -'
Address: S-3 cQ A0027- �O
Legal Description: %% r, �t �4i2 1E _' Z� C' —0/6
Property Tax ID #: I r UT �� i 0�7 + Lot No. _
Site Plan Name: ISC1 •z% 6/1 Block No.
Project Name: 11
Setbacks Front_ Back: Right Side: _ j 1 Left Side: i
rt na work to jeperformedunder t is permit —check all apply:
VAC L__I Gas Tank ❑Gas Piping _Shutters Windows/Dc rt` l
Electric Plumbing Sprinklers E]Generator 2/Roof
Total Sq. Ft of Construction: �_sc�' S�Ft.j of First Floor: I�
Cost of Construction: $ _Ss,r .,� Utilities: L nSewer Septic Building Height:'',.
�J .Y !;+ St f i.r )iYY 1 i Y..Y Y 4• �:' Y" (4-*C
01wg' M.:
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CONTRACTORh �, r
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r F, � 9 F=.IC9`
Name ' �
Name:{ EA S' -
P ^ r�'i9L'I'Company:l#�
Address: S'C9r �. % [3' •
�
. _a
City: {, _;-' ,, ' _ ,Mate: �.
Address:
Zip Code:,
City: _id6 371,41:2 State:�
Phone No ^'''4 �•'y�;S
Zip Code: Fax: "
E-Mail:
Phone No.
E-Mail: i L k1t0j ' k 13 Q cX ,. C-01y)
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
State or County License: [' 1C Q!�C2 �
if value of construction is Sz5ou or more, a KtLUKUCU Ivoilce UI wuunou�.c1ncnL cMuu vu.
DESIGNER/ENGINEER: _ Not Applicable
Name: / ` -
Address: a.oj,
City: _5g6ASr j, AQ State: ram..
Zip: _!,296y Phone: •-ep2l
FEE SIMPLE TITLE HOLDER: — Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City.
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
strucctture. Pleasle consult nw with your Home Owners Association andrreview your deed for any restrictions which maor
aprohibit such
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 your Notice of Commencement.
A/
0
Signature of Owner/ AgentVLessee
STATE OF FLORIDA
COUNTY OF
The f ,flQing instrument was acknowledged before me
thisJdayof 20Y
lam, un n/1i /1 C/i �n Cl ) , c C
(Nameoersor,_ 6knowledg'WVL
(Sign ur of Notary Public- State of Florida )
> >>-���-mow �x:�..o.� ,::.:-..:....._......:•�:•= .,.:.....� .,
Personally Known OR Produced Identification
Type ofl------- -----
Com
Revised 07/ 15/2014
Sig re of Contractor/License Holder
S'NATE OF FLORIDA
COUNTY OF
_oL
V,
The r ing instru ent was a mowledged efore me
thisay of X20 by
(Nam ff pers n acknowledging)
(Signature of Notary
1Pubttii ate of Florida )
Personally Known T QR Producedidentificati=
Type of Identification Produced
# I`F 24483(6eal) Commission
iber 4, 2019
.inw..nu WN183.7o»
eoedATen
4 FF 244339;i
her 4, 2019 '
REVIEWS
FRONT
COUNTER
ZONING
REVIEW '
SUPERVISOR
REV EW
PLANS
REVIEW
VEGETATION
REVIEW
SEATURTLE
REVIEW
MANGROVE
REVIEW
DATE
COMPLETE
d-1 l
INITIALS