HomeMy WebLinkAboutBuilding Permit Application.PPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: G, "`t C' l ( Permit Number:
Building Permit 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 Commercial Residential
PERMIT APPLICATION FOR:
Address: _1(j .E , s4����
Legal Description:
Property Tax ID #: 3 `k� `.i - 'Ju -
i C.�i+E= - C ��- ' ( _ Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Block No.
%ke- fif r 3 � - eros / y s�r� C�jA, nsc._
Mechanical
Electric
_ Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
Cost of Construction:
Na
_ Gas Piping
_ Sprinklers
_ Shutters
_ Generator
Sq. Ft. of First Floor: _
Utilities: _ Sewer _ Septic
Address: -
City: C'n"$ `JF-, CL'x.State: FL
Zip Code: , Cri 5Z Fax:
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
— Windows/Doors
Roof
Building Height:
Name: Curtis Sawrnon s
Company: (AsTdm A(r Sf'ems ) tj c -
Address: tl IS S E Ti ren Di^
City: Vo -r ST U•t 0State: El
Zip Code: 34 9, Fax: `1ia 33S
Phone No. 77,) 33,5 3 0- 3 2
E -Mail: CuSfiQ1r ¢u V C.o ) c.cm
State or County License: Cfl C 0 5 I8 /O S�cLiz
If value of construction is256Tor more, a RECORDED Notice of Commencement is required.
M
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I
DESIGNER/ENGINEER: _ Not Applicable
----=
MORTGAGE COMPANY: Not Applicable
Name:
_
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
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 recori$iVg your Notice of Commencement.
Signature of owner/ Agent/ Lessee
Signature of Contractor License Holder
STATE OF FLORIDA
COUNTY OF 311 1_�6clt_i_l
STATE OF FLORIDA
COUNTY
OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of . 20_ by
this day of . 20_ by
C1i,Lr'7LI M Molls
writs mma4S
(Name of person acknowledging)
*44�e__ zd�_
(Name of person acknowledging)
—_ . :�� xgn4�6
(Signature of Notary Public- St to of FI da)
(Signature of Notary Public- State of Flo$a
a )
Personally Known ✓ OR Produced Identification
Personally Known kl OR Produced Identification
Type of Identification Produced
Type of Identification Produced
n CHRISTINE B. ENGLISH
Commission No.E�s1r d�� * (e4I)MYCOMMISSION#EE8592
EXPIRES: April 4, 2017EXPIRES:
`° : ' . `'oCHRISTINE B. ENGLISH
&Commission No. )MYCOMMISSION #EE 85928
April
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4, 2017
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
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RECEIVED
DATE
COMPLETED
7
ev.