HomeMy WebLinkAboutBuilding Permit Application i
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED, t
Date- Permit Number'
RECEIVED
Building Permit APpiication DEC 3 0 01
Planning and Developn5entServices PERr4rr 'iNG
Building and Code Reglddtron 07vision St. Lucie}ounty,FL
.2300 Virginia Avenue,Fort Pierce PL 349V /
Phone:(772)X162-1553 Fax:(772)462-1578 Commercial ReSidential
PERMIT APPLICATION FOR: To Select from dropb*o4,* click arrow at the-end of line +
Address: -In .
Legal Description; j
Property Tax lD,#: � 1 � � tn coo- Lot No. [
Site Plait Name: Block No.
Project,Name•
Setbacks Front_ Back; _Right Side: Left Side: .
�.
its na wor to a o'rme un er t s perms —c ec 'a app y;
HVAC - Gas Tank LjGas Piping _Shutters windows/Doors
IjElectric i�.i•Plumbing OSprinklers Generator Roof
Total Sq,Ft of Construction: 5 .Ft,of First Floor;
Cost of Construction:!$ Utilities: Sewer Septic Building Height;
Name WNIA
Address: . 'Company: j
city: State: Address•
Zip Code: , ''Fax: City ��`*� State.•
PhoneNo. � �- lam- `'7 Zip Code: Fax 1
E-Mail: Phone(Vo.
Fit]in fee simple Tltl�Hotder on next page(If different E-Mail:
from the Owner list4d above) State County License; �' ]
If value of construiWO is$2500 or more,a RECORDED Notice of Carntnencement is required.
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DF
StGNER/ENGINEER: _Not Applicable MQRTGt GIF COMPANY: Not Applicable
Name: ! Na�rie:
Address: Address:
City: State: City: State>
Zip: Ph ne: Zip: Phone:
FEE SIMPLE TITLE H LDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name
Address: I Address:
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 n' representation that is granting a permit will authorize the permit holder to build the subject structure'
which is in conflict with al3y applicable Nome Owners-Association rules,lbylawa or and covenants that may restrict or prohibit such
structure.Please consult, ih your Home Owners Association and revle 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 r6ott s and.accessory uses to another non-residential use
WARNING TO OWN�R;Your failure to Record a Notice of Coni mencernent may result in your•paying twice for
improvements to yiaurproperty.A Notice of Commencement must be recorded and posted on the jobsite
before the first inspo- ion. If you intend to obtain financing;consult with lender or an attorney before
commencing work or, recording your Notice of Commencement.
Signature of Owner/Ags�n/Lessee Sign2t6re-of Contractor/License older
STATE OF FLORIDA 1 STATE OF FLORIDA
COUNTYOF COUNTY OF —�� --
The f r oing Inst n w sac nowledge before me The r oing ins mp was�,c,,�t� ledged before me
th(�day of '�� ZO by this day af � 20y
A -Pail
(Name of periackno ledging . (Nbine of Pers n acknowledging
ling]
0
(Signature of Notary P j Iic-Staja#Florida) (Signature of otary P lic-State f ri 'da}
Personally Known OR Produced Identification Personally Known _OR Produced Identification
,Type of Identification Produced Type of identification Produced
-Commission N'o. `-' i (Seal} Commission N, J (Seal)
CRYSTAL MARIE'CRt?ZADB °' ;: CRYSTAL MARIE CRUZA00
MY C0MMi$SK)N#EE127d83 MI SK?Al#wE 10463Revised 07/15/201 EXPIRES jun&25.2415 F3(PIRES June 25.206
M-0153 (407)9984153 Fk�idxNottufserviwCan+
REVIEWS FRONT ZONIN8 SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COLIN TER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS .
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