HomeMy WebLinkAboutBuilding Permit Applicationru.L,+ t-MILAULt iNFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number-
Buflding Permit Appfication
Planning and Developmentservices
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 4.62-JS53 Fax: (772) 462-IS78 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENTLO CATION.
Address: " Ct11��v
Legal Description: t
9
Property Tax ID#:� � �"1 z
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
[DETAILED DESCRIPTION OF WORK:
' .z l ---A
Lot No. 4-!,(
Block No. (3(f)
CONSTRUCTION INFORMATION:
A la,worR to e e Orme un eat ispermit—c ec ail
HVAC �ep�Iumbing
Ga Tank Gas Piping In Shutters Windows/Doors
Electric Sprinklers M Generator ❑ Roof
Total Sq. Ft of Construction:
Cost of Construction: $ S5 �
OWNER/LESSEE:
5 Ft. of First Floor_ _
utilities: Sewer Septic
Name
Add s:. �- t
City: Stater
Zip Code: r ' Fax:
Phone No.
E -Mail:
Fill in fee simple Title Holder on nest page ( if different
from the Owner listed above)
CONTRACTOR:
Name: 'Tb!UeDh TUB [V
Building Height
Company: G e i �srnbi c.�,S U -
Address: OiQ _cu i+o vp_
City: �b it State: rl
Zip Code: ?::,g4sZ Fax -.7-72 - 3SW D,690
Phone No. 1-7 - 3;? -7- 3� Q �
E -Mail: C-�,essslur�b�,�� r� ori
State or County License: �_ G lid -L t
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
BONDING COMPANY: Not Applicable
Name:
Address:
Address:
City:
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 no representation that is granting a permit will authorize thepermit 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
commencinia work or recordinl3 vour Notice of Commencement.
re of Owner/Less ractor as Agent for Ownerignature of Contra
O_iUOFCOUNTY OF f �c STATE
O�. ( WC\e
The for',going instr t was acknowledgefore me
this 47� day of 20 Wby
(Name of person acknowledging )
d
(Signa re of Notary PPOR
tate of Florida j
Personally Known Vf Produced Identification
Type of Identification Produce _
MAMAH MILLS
( mfission # FF 023763
Commission No. �m
'?^o� xpiFes June 3 2017
EvidedT .ru Troy Faip hnra,n{e 600-38a 7018
Revised 07/15/2014
REVIEWS FRONT I ZONING
COUNTER REVIEW
DATE
COMPLETE
INITIALS
The fopgoing instrument was acknowledged before me
this day of �Q�\ 20 ,J—T�J by
(Name of person a knowledging )
(Signat re of Notary Public- ate of Florida }
Personally Known " OR Produced Identification
Type of Identification Produced
n 4PRAH WLLS —f>
Commission No. (5#✓Aolssion#FF 023763
axpE es June 3,20 1 7
SUPERVISOR PLANS I VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW