HomeMy WebLinkAboutpermit application.PP LICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Planning and Development Services
Building end Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Permit Number:
Building Permit Application
ff
Commercial Residential y
Address: 6 . fl� F� k"'Ll
Legal Description:
Property Tax ID #: —1� � �/-,/2177J _o�v -9 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: /
Cost of Construction: $ 3 I
Name !-i_CJCr S• Dt a d- Annc,� C
rmn -
— Gas Piping
_ Sprinklers
Shutters
_ Generator
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic
Address: 53 (due cie to, renMiselvj
City:E �unie �xC NtOA&L Stater
w
Zip Code: ,) 5 jC PI Fax:
Phone No. 5q3 ` � 5 c — 2.HY
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Windows/Doors
Roof
Building Height:
Name: &urtt5 So_wrn0n S
Company: Ck,5 dm AL 5�I s fe rns IAl c.
Address: IkeIS SE Ti II ap_Qren Dr
City: PC 9-7 ST L1tC1f— State:
Zip Code: 34SZ Fax: '77; J35 1 t6 F
Phone No. 771 335 JQ L
E -Mail: C.i1Sfi41r- Su � V C'0 )
State or County License: Cfl C 0 5 I R !D - S- CLI -
IIIf value of construction is 25Kor more, a RECORDED Notice of Commencement is required. II
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 recor our Notice of Commencement.
'
Signature of Owner/ Agent/ Lessee
Signature of Contractor License Holder
STATE OF FLORIDA
COUNTY �t
STATE OF FLORIDA
OF ! ^,c._,
COUNTY OF 'AZ! 4c elc
The foj going instrument was acknowledged before me
Ti
The forgoing instrument was acknowledged before me
this day of T • L) 20-L by
this _.�L day of r --e1 20 1) by
rnMa11S
�%crtls S'HmmeIS
(Name of person acknowledging)
(Name of person acknowledging )
(Signature of Notary Public- St to of FI tda)
(Signature of Notary Public- State of Flo ' a67 )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification Produced
Type of Identification Produced
S. ENGLISH
Commission No. E� �sy�V * e�IiNEE8592
`R Pc LTft
°` ; `� CHRISTINE B. ENGLISH
"Commission No. E��� 1f,d�y * )MY CO
pril 4, 2017
s EXPIRES: April 4, 2017
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OF c1- Bet Notary S -
s «oQ'°p Bonded Th Budget No taN J'erva
REVIEWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
REVIEW
VEGETATION
SEA TURTLE
MANGROVE
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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