HomeMy WebLinkAboutpermit aplication?PLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application
Planning and Development Services
Building end Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address
Legal Description:
C
PropertyTax ID #: ►���� - l� ��� - 3 _ Lot No.
Site Plan Name:
Project Name:
Block No.
Setbacks Front Back: Right Side: Left Side:
C�tA As C- &-Irr l o h w I y Seel
ditional work o be performed under this permit -Check all that apply:
Mechanical — Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator — Roof
Total Sq. Ft of Construction:
Cost of Construction: $ ��61_
Sq. Ft. of First Floor:
Utilities: —Sewer _ Septic Building Height:
Name /�l i ce C� a inn �cLritil re l �cz,
AddreA- �✓�
City: Fod State: ��-
Zip Code: Fax:
Phone No. 9 -9d, 73
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: i✓udil5 isvM on .5
Company: CA s -re ; i r 5� +ems C.
Address: r"
City: 'Po State: �L
Zip Code: 34 qSL Fax:
Phone No.
E -Mail: L fi r o f
State or County License: Cfl C o 5 I
If value of construction is 25,Kor more, a RECORDED Notice of Commencement is required.
P�-:J = w,
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 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
commencing work or recorM your Notice of Commencement.
I LI
Signature of Owner/ Agent/ Lessee
Signature of Contractor License Holder
STATE OF FLORIDA
STATE OF FLORIDA
it
COUNTY OF 31f
COUNTY OF l=t-t'�
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of j;4k_A eo 20_4 by
this i day of i1 .2GQeJ 201 �L by
L�Lkrfr; ,)ArrlrncnS
C,;tctI S'Nmmcn�
(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 o;, CHRISTINE B. ENGLISH
o
?�"a •.:P • CHRISTINE B. ENGLISH
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Commission No. �Eif'syJ* e�l�IYCOMMISSI0N4EE8592
E4 Commission No. EEc1'J 1/,dc3��% ad)' MY COMMISSION I EE 85928
EXPIRES: April 4, 2017
EXPIRES: April 4, 2017
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OF f,6, Banded Thm Budget Notary Servic
P
S E` F'_ Bonded Thru Budget Notary Serv,ce
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