HomeMy WebLinkAboutBUILDING PERMIT APPLICATION.PPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 0 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: �Ifak�. 164_4_41
Legal Description:
Property Tax ID #: / -' 0/ — 5900 -3 __ Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
.S �-t'tr� .2 A Z -/11C_ 1lor /{/e e--)Aric /VStq' /c'/t''
Block No.
Mechanical
_ Electric
_ Gas Tank
Total Sq. Ft of Construction:
Plumbing
_ Gas Piping
_ Sprinklers
_ Shutters
Generator
Sq. Ft. of First Floor:
Windows/Doors
Roof
Cost of Construction: $ 7 z- 70 Utilities: _ Sewer _ Septic Building Height:
Name 1�91rlc•rw f/'rkkn e
zt-
A J f/,Zd' 1` d
City: 13Q� Ltfz -2z- State: LL -1
Zip Code: 1fq Fax: cull d lb JV& Oc'F /
Phone No. 772 V.Z
E -Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: Curtis S'ammon S
Company: CusTem Lc 541 s ems )>L G
Addresss: t k l S S l: l i l( a p Q rf r� D,-
City:
,City: CO Q z � T Lk O I c- State: �L
Zip Code: 34 qSZ Fax:
Phone No. 7 7,2 5 I -• 3 a 3
E -Mail: custoor Su Coo 1 �rrn -
State or County License: Cfl C 0 5 I l O- S e
ifvalue of construction is25Kor more, a RECORDED Notice of Commencement is required.
7.f00 —
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 STATE OF FLORIDA
COUNTY OF ��•�{�',L2- COUNTY OF xl�� dyl,c.Gc,e-
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this �_ day of 7AA4-e`� , 20_ZZ by this 9 day of 041tic?k , 20_i.�' by
Ott rf,r; 5A mrnoil S C 6Crt13 6'm mrnenS
� (Name of person acknowledging) (Name of person acknowledging)
{Signature of Notary Public- St to of FI tda) (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
CHRISTINE B. ENGLISH �•�" o,.
-�'"'�a �° �•••••`c CHRISTINE B. ENGLISH
°` .-••. �%,
Commission No. �� �� y��� * • e�I)ti1YCOMAIISSIONdEE8592 ": Commission No. EEcf'J li,dcl��i * a<r)IdYCOMMISSION 0EE85928
' EXPIRES: April 4, 2017 EXPIRES: April 4; 2017
FLov`� Bonded Thn; Budget Notary Servicks
Ee= Foe- Bonded Thm budget Notary Serrice
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
� COMPLETED
Rev.