HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICABLE INFO MUST BE COWALETED FOR APPLICATION TO BE ACCEPTED 1 f,,/
Date: Permit Number: �` LQ . o(P'4`f"
Building Permit Application
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
PROPOSED IMPROVEMENT. LOCATION: '
Address: i
Legal Description:
% 1 Closer l•v% PO Klde..
m c) v e- �l TCk en/ is1,4.v d .3 /Qe-T
Db— .
_ yqa
CONSTRUCTION INFORMATION;
Additional work to e e orme under this permit — check a apply:
0HVAC 13 Gas Tank ❑Gas Piping _ Shutters Q Windows/Doors
EjElectric E Plumbing []Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction: $ (� U Utilities: 0 Sewer E]Septic Building Height:
OWNER/LESSEE: '
*CONTRACTOR..
_. .
Name—r,homAs P Tlexi I -
Name: 0 be.-,-r— F C'eN
Ts�
Address: 7.3 % Ali I/ e c a n4 Q b ec
Company: Zcc bm S
City: Wei do41 S n rCi iv a State: /i0
Address:S&J NW bool e
Zip Code: 40 3 O� Fax:
City: 7 � � State: ems'
Phone No.. / y — y Qa — $0 9 3'
Zip Code: 3Y 9 e6 Fax:
E-Mail:—rPE SL- 71/7 a &,_-mAI 1. Con
PhoneNo.7,W - 4/ ff— 90iJ7
Fill in fee simple Title Holder on next page ( if different
E-Mail: Ate- l i t e m sy • ca.,,
from the Owner listed above)
State or County License:
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _Not Applicable
Name:
Address:
City State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name: _
Address:
City: —
Zip:
Phone:
Not Applicable
MORTGAGE COMPANY: _� Not Applicable
Name:
AcIclress:
City: State:
Zip' Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
' Not Applicable
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 prohibit 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 your Notice of Commencement_
as Agent for Owner
STATE OF FLORID
COUNTY OF_
The f r oing instrument was acknowledged before me
thigy of 20 I_by
UKA
(Name of person ac owledging )
(Signature o Not ry Public -
Personally Known
Type of Identification uc
Commission No.
Revised 07/15/2014
{{YY Public, State of Floru
( efmmission# FF 1613331
My comm. expires Sept,
REVIEWS I FRONT I ZONING
COUNTER REVIEW
DATE
COMPLETE
INITIALS
6� v
Contractor/Lic
STATE OF FLORIDq
COUNTY OF , �1,-
The i g instrument was acknowledged before me
thisford y of 20 by
(Name of persona nowledging )
(Sig ure of ry Public- St e f Florida)
personally Know OR Produced Identification
ype of Identification Produced F( _ L0?__
No, KlULLYNIOLLo'
Loam[ � Notlly 13u6N�,13f�to of
Cof imlellom FP 16
SUPERVISREVIEWOR RE EW I PLANS I VEGETATIONI S EV EWLE I MANGROVE