HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATIGN TO BE ACCEPTED
Date: Permit Number:
_ ILL61 �unJ i. �ulliU�pll 11C
BuildingRermh 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 Commefdal Residential
PERMIT APPLICATION FOR: To Select frorh dropbo. click arrow at the end of tine
PROPOSED IMPROVEMENT LOCATION:
Address: t iU �1 ct
Legal Description:�k iv ►7 oca
Property Tax lD #: rJ�r " C� fig' l / V- ► V `��
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
R?' P) la e :E—/`�7 d ilex
Lot No.
Block No.q
CONSTRUCTION INFORMATION.
Additional work to be ertormed under this permit - check all j apply: Q
QHVAC E] ❑Gas PipiGas Tank ng L J Shutters Q Windows/Doors
QElectric Q Plumbing QSprinklers L,=1 Generator Q Roof
Total Sq. Ft of Construction: S . F. of First Floor:
•��
Cost of Construction: $ _ �#,� Utilities: Sewer QSeptic Building Height:
OWNER/LESSEE: COVTRACTOR:
Name , C►{ \ n1 i 2 Nar',.:
Address: P -) . QDY �qA
City: i-� (-\tiry 5-! P \` State:i� Add,-ss:q�1, SW %,\\-MocL€ 5t"
Zip Code: l� Fax: city) D� \ S" -N, `i_kA C T 'i— State:Y-A—
Phone No. ►1 C1 � �i IZip bde: °SA q V q_3 Fax: h cl -'t h. 61
E -Mail: NmLs�WAUC'\ Vc��t�,a,1. tnn Phor1 No. %n9-0 "C8'A
Fill in fee simple Title Holder on next page I if different E -M4'1: 0 C� A D\ , C.0 SVl
from the Owner listed above} Statf. or County License:
If value of construction is $2500 or more, a RECORDED Notice of Comma ncement is required.
TION:
rGAGE COMPANY: — Not Applicable
Phone:
FEE SIMPLE TITLEHOLDER: — Not Applicable 80fl IDING COMPANY:
Name: Narr a:
Address: Add ass:
City: City
Zip: Phone: Zip: Phone:
State:
Not Applicable
zl I certify that no work or installation has commenced prior tc the issuanc
SUPPLEMENTAL CO-NSTR Ci't LIE#7t LAW iFril#!
DESIGNERIENGINEER:
� Not ApplicableMO
Name:
Nan
Address:
Add
City:
State: City
Zip: Phone:
Zip:
TION:
rGAGE COMPANY: — Not Applicable
Phone:
FEE SIMPLE TITLEHOLDER: — Not Applicable 80fl IDING COMPANY:
Name: Narr a:
Address: Add ass:
City: City
Zip: Phone: Zip: Phone:
State:
Not Applicable
zl I certify that no work or installation has commenced prior tc the issuanc
of a permit.
St. Lucie County makes no representation that is granting a permit will ai
which is in conflict with any applicable Home Owners Assoc ion rules, I
horize thepermit holder to build the subject structure
laws or and covenants that may restrict or prohibit such
structure. Please consult with your Home Owners Association and reviev
your deed for any restrictions which may apply.
In consideration of the granting of this requested permit, I d. hereby ags
e that i will, in all respects, perform the work
in accordance with the approved plans, the Florida Building Codes and S
Lucie County Amendments.
The following building permit applications are exempt from undergoingfull
concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen room
3nd accessory uses to another non-residential use
WARNING TO OWNER: your failure to Record a Notice of Corn
iencement may result in your paying twice for
improvements to your property. A Notice of Com rnencemen
must be recorded and posted on the jobsite
before the first inspection. If you intend to obtain financing,
onsult with lender or an attorney before
commencing work or recording your Notice of Corumencem,
nt.
Signature of Owner/ Agent/ Lessee
STATE OR
s a
The forgoing instrument was acknowledged before me
this day of 20 14 by
Signa ire of Contractor fCcense molder
STATE OF FLORID
COLI ITY OF - Uk,e'�S_
The fc , going instruent was acknowledged before me
thisIAC day of 1 'd( y20 by
1c)C _ ( i ewl n c r
(Name of person acknowledging) JNam ofperson ackciowle i g )
(Signature of Notary -Public- State of Florida) ( g " ure"offac- tate ofd j
Personally Known OR Produced identification Perso pally Known OR Produced ldentificatifn
Type of Identification Produced Type f Identification Produced _ : 7 u c ` C t t`c.t--'-R J
Commission No. (Seal) Comr-ission No. y _ COLLEEN DEM I)
NOTARY PUBLIC
-STATE OF FLOR111
.
Comm# FF065960
Revised 47/15/2414 Expires 10/24/2017
r
REVIEWS FRONT ZONING SUPERVISOR PLAT S VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIf At REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS .
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