HomeMy WebLinkAboutBuilding Permit ApplicationPPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: l L ' ' 1 Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Building Permit Application
Commercial Residential
Address:
Legal Description:
Property Tax ID #: �j�( �_L (- '�O1 — C -k-195 ~ (jam— Z Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Mechanical
Electric
_ Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
L {_1 � � -�C( T), �- w)
_ Gas Piping
Sprinklers
— Shutters
_ Generator
Sq. Ft. of First Floor: _
Cost of Construction: $ 15o3 -'-
D Utilities
Name l—C:�r1 C,- � , )) -L('� C
Address: 1 �;-b
City: State:
Zip Code: Fax:
Phone No. �-y k 3�5q
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
— Windows/Doors
Roof
Sewer _ Septic Building Height:
Name: Curtis Savnmon -5
Company: Cus-rem Vc 5� S fe ins `>u L
Address: (k IS S 6 11 ka,,-,- Q rein D,- -
City: _PC vu ST UC « ti State: fL.
Zip Code: 34 &Z Fax: `77a J35 ) �6,�
Phone No. 77� 33,5-3x32
E -Mail: (LtiSfi4if- C1u < V CAS ) •C,m
State or County License: Cfl 0 0 5 1? 1 D Sae
If value of construction is260Tor more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable
Name: _
Address:
City:
Zip:
Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: _
State
_ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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 recor¢oiVg your Notice of Commencement. .,
Signature of Owner/ Agen
Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF �7� COUNTY OFA
The forgoing instrument was acknowledged before me
this Q day of �� c. ��l , 20k "1`1 by
�ur rS �H vnmon9
(Name of person acknowledging)
(Signature of Notary Public- St to of FI ida )
Personally Known ✓ OR Produced Identification
Type of Identification Produced
CHRISTINE B. EN!"I
Commission No.n Weal)MY COMMISSION IEE8592
EXPIRES: April 4, 2017
�'' EOF Fti�P\Op Bonded Thro Budget Notary S"
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
The forgoing instrument was acknowledged before me
this (L day of 11�7Q�7L ��£ r , 20_LJ J by
Cct f- l's S"A m m" rl
(Name of person acknowledging)
(Signature of Notary Public- State of Flo .a )
Personally Known ✓ OR Produced Identification
Type of Identification Produced
CHRISTINE B. ENGLISH
Commission No.Er�'S1/��y * )MYCOMMISSION IEE85928
EXPIRES: April 4, 2017
E()'FO Bonded Thru Budget Notary Service
UPERVIS
PLANS �
S REVIEWOR I REVIEW VREV EWON I S REVIEW TURTLE
I MREVIEWVE