HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number:
- 3 2
K Building Permit Applicati®n
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce Ft 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial � Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of Zine
PROPOSED IMPROVEMENT LOCATION:
Address: 3 3 2 CQ-- A, 1,
Legal Description: d` `;�%n, 3
i 4,
Property Tax ID #: ,� 3 3 V
Lot No.
Site Plan Name:Block No.
Project name:
Setbacks Front Back: Right Side
DETAILED DESCRIPTION OF WORK:
Left Side:
i f J !� �W I C'.•iv d` Sr E°° w.• Gi �] Cwt L .66 r -O.v�. V Aj
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CONSTRUCTION INFORMATION:
A )tat d' ons sero tr a bee orme uner t is permit -c;
E1NVAC Gas Tank ❑Gas Piping
Electric Plumbing Sprinklers
T otal Sq. Ft of Construction:
Cost of Construction: $ 1106.0
OWN ER/LESSEE:
it I
app Y�
� Shutters Windows/Doors
[ I GeneratorUnF= i
Sq. Ft. of First Floor: _
Utilities: 0 Sewer ! =I Septic
Narne - 1
Address: _1 3 7 Tc� X , 5
City: i l > J — State: "
Zip Code-, c,i 5~! Fax: : 7Gl
Phone No.
E -Mail:
Fill in fee simple Title Holder on next {sage (if different
from the Owner listed above)
CONTRACTOR:
Building Height;
Name: ,UI l YLd eJ'w*-C---
Company: r1,S (_CA1C,.f
Address: Zio&Z SL—N Cup GK -
City: S� State:
Zip Code: 3Yq-(-3 Fax:= 679-/6o 1
Phone No. Tia --7 -Z34—fS..
E -Mail: e j; e, lo -e-1 an op c4
State or County License: _L&_ 41/L12Q,3
If value of construction is $2SOO or more, a RECORDED {Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Nat Applicable
Name:
Address:
City: State:
Zip: Phone:
EEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY::Not Applicable
Name:
Aaclress:
City: State:
Zip: Phone:
BONDING COMPANY:
Name:
Address-,
City:
Zip: Phone:
—Not Applicable
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie County snakes no representation that is granting a permit will mauthorize rmit holder to Build the subject structure
the pe
which is in conflict with any applicable Home Owners Association rules, bylaws L, and covenants that may restrict or prohibit such
structure, Please consuls with your hoe 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 aft respeas, perform the work
in accordance with the approved pians, the Florida Building Codes and St. Lucie County Amendments.
The following building permit applications are exempt from undergoing a furl 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 fender or an attorney before
commenclDwork r recordin our Notice of Commencement.
A
_ Signa re of Owner/ Lessee/AgentSignatu4oC!-t,actor/License s
#-folder
STATE OF FLORIDA i
COUNTY OF 5 -k �f — STATE OF FLORIDA
- - COUNTY OF
The forgoing instrument was acknowledged before me
this G day of 4pee.,; ?o .t V by
(Name of Person of person ackr owle�'��'g)
(Signature of Notary Public- State of Florida }
Personally Known OR Produced Identification
Type of Identification Produced
Commission Not (SEORK
a aJ My COMM] SS10N �&FF0442
EXPIRES AUPUSt 12, 2017
Revised 07/15/2014 (407139a.ar53 �loriuoNr f �ryscrf,ccr.co rr
REVIEWS FRONT ZONING
SUPERVISOR `
COUNTER ; REVIEW i REVIEW f
COMPLETE
INITIALS I I
The forgoing instrument was acknowiedged before me
this S day of 20 by
(Name of person acknowledging)
4A(Signature of Notary
RPublic-
Personally Known p. OR Produced Identification
Type of Identification Produced
qommission No.V'9
r••-.,_ icy n
KIRK AE!! KATZ
�;Q;..: EXPIRES flugust 12, 201
398-0153 c3...:a_.
PLANS VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW
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