HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONALL APPLICA LE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED h
Date: 1 SCANNED Permit Number: J lL� -�Jo
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division 1
2300 Virginia Avenue, Fort Pierce FL 34982 AJ
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of lines q_C,6� t III
IPROPOSED IMPROVEMENT LOCATION: III
Address:
Legal Description: DIET >6e>z S Ati[,[���
Property Tax ID #: C)� e-D6 ZO Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
No.
I DETAILED DESCRIPTION OF WORK: JP !�
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CONSTRUCTION INFORMATION:. III
HVAC LJ Gas Tank UGas Piping
Electric Plumbing []Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
J
Shutters MVAx&W ;/Doors
Generator ❑. Roof ❑ Roof pitch
StI�Ft.� of First Floor:
Utilities: nSewer ❑Septic Building Height:
OWNER/LESSEE:
CONTRACTOR:
Name I��c?T`F tact ( [ A J,)_�(L
Name: _ CPz15-,-brnPTP--
[ C-T1 ?JN it t L
Address: 990I
Company:
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City: 'Pz"zzAcu State: 11-
Zip Code: 3` i9� Fax:
Phone No. ?-72. 2-3Q33J7
Address: �(e2 7 Ily
Sdr-Y 612zv= NQ�I
City:yIC
Zip Code: 3
Phone No. -n 2. 2,c)
t.'Z- State: F^c
Fax: YI"b (0241g?,
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E-Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
E-Mail:
State or County License:
C,L crt��ZOZ�O
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: I III
Name: Cvv MIn�
Address: 5'1X( �1 crW4r�C Res
City:State: f-G_
Zip: "D Phone: -112 q60 '7 T S 1
FEE SIMPLE TITLE HOLDER: 'A --Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _Nd Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
—V Not Applicable
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 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 vour Notice of Commencement.
signature of Uwner/Lessee/Contracro-r as Agentfor Owner Signature cif Contracto(//Licens611al8er
STATE OF FLOP* r STATE OF FLORIDA ))
COUNTY OF CIL�(� COUNTY OF , �Ie UC 1.
Ther oing instru �ent�"ans ^ancknowledgedfore me The forgoing instr ment was acknowledge before me
this ay of V 20 _(by thisay of 20 acknowledge
%.rA �� kc�%n�� �� rrk5 �� y J
(Name of person acknowledging (Name
of person acknowledging )
(Signature of Nota Public- State of Florida) / (Signature o otary Public -State of Flo i ) , /
Personally Known OR Pro c d I ti ication V Personall ed n ification V
Type of Identification Produced Type of I y ° fisg��ce
o. (Seal) Commis °mm/aDr� c81a1aaJ
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
EVI W
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
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IN