HomeMy WebLinkAboutpermit application.?PLICABLE 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:
Address:
Legal Description:
M 4c/d
Permit Number:
Building Permit Application
Commercial` Residential
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Property Tax ID #: uc �� o� �� lIT_PP (%Ic Lot No.
Site Plan Name:
Project Name:
Block No.
Setbacks Front Back: Right Side: Left Side:
r /0
Mechanical _ Gas Tank _ Gas Piping _ Shutters — Windows/Doors
Electric _ Plumbing
Total Sq. Ft of Construction:
_ Sprinklers — Generator _ Roof
Sq. Ft. of First Floor:
Cost of Construction: $ 6W'2 I- Utilities: —Sewer —Septic Building Height:
Name A,Iden Pencil HCtl
Address: / geo CE- lkn Pen it h l_
City: Fo R i �i E f t State: f
Zip Code: _j y S V,5' Fax: Rol �yJ' O ZoI3
Phone No.—
E-Mail:—
Fill
o._E-Mail:Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: Curtis Sa,wrnon S
Company: ('AAs—rem LtLr 4S fe b3. `AJ C.
Address: l(elS SE `Ur I(cta_o�r�en ,-'
City: 'Po T �T LkCt� State: EL.
Zip Code: 34 SZ Fax: X17; 33S ► 4b F
Phone No. 77j 33 S ' 323 '2-
E -Mail: C. T r 01
State or County License: CA C o 5
ifvalue of construction is?5Wor more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable I MORTGAGE COMPANY:
Name:
Address
City:
Zip:
Phone:
State:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
Address
City: _
Zip:
Phone:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name: _
Address:
City:_
Zip:
Phone:
_ Not Applicable
State:
Not Applicable
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 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
co mencing work or recor our Notice of Commencement.
..
_
Signature of Owner/ Agent/ Lessee
Signature of Contractor License Holder
STATE OF FLORIDA
�7f ��
STATE OF FLORIDA
COUNTY OF J
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of �%l2 r��J 120 / 7 by
this_J day of , 204�2 by
(!ucr_LIrnme11
Hrnrn',/A S
(Name of person acknowledging)
(Name of person acknowledging )
(Signature of Notary Public- St to of FI ida)
(Signature ' of Notary Public- State of Flo a )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification Produced
Type of Identification Produced
�Y°
�o".••`�'-� CHRISTINE B. ENGLISH
Commission No. f,67?5 * e I�iYCOMMISSION EE8592
EXPIRES: April 4, 2017
•- CHRISTINE B. ENGLISH
'••
"-Commission No. EEd'J ���dYCOMMISSION-EE85928
EXPIRES: April 4. 2017
��EOF
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Rev. 7/2014