HomeMy WebLinkAboutBuilding Permit Application.PPLICABLE INFO MUST BE COMPLETED FOR APPLICATION'TO BE ACCEPTED
Date: "Zo 17 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
PERMIT APPLICATION FOR:
Address: L4 I.f UP P i (1 &- r` C C C> (L
Legal Description:
Commercial Residential ''/
Property Tax ID #: 5 H C) Z " (0 66 ' �d CPH — b 00 (,o Lot No._
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Mechanical
Electric
— Gas Tank
Total Sq. Ft of Construction:
Plumbing
Cost of Construction: $ 314 50 , 0 0
Name '= \k o -c -C()
— cnecK a
_ Gas Piping
_ Sprinklers
_ Shutters
_ Generator
Sq. Ft. of First Floor: _
Utilities: _ Sewer _ Septic
Address: �k la D'I P L t U4f ee. t>2 -
City: r oT �- er-ce- State: _EL_
Zip Code: 5 L( q Z Fax:
Phone No. (e 1 -7 �J
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Windows/Doors
Roof
Building Height:
Name: Curtts Sawrnon S
Company: (C,tas-r&,M A t'r 5!� S fe MS )lu G
Address: Ili IS SE 91 r I (a-PQ raeN D,-
City:
,City: POQ-7 ST L4C �f_ State:
Zip Code: 349Sd Fax: ' 7,1 33S 1 UX
Phone No. 77j 33,5 -3a3'2-
E-Mail:
30232E-Mail: Custa,\r ¢u V ao ) •CC-"
State or County License: Cfl C 0 5 19 IO She
If value of construction is 26Kor more, a RECORDED Notice of Commencement Is required.
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 bylaws
rules, 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 recordhpg yourrecord' Notice of Commencement.
Signature of Owner/ Agent/ Lessee
Signature of Contractor License Holder
STATE OF FLORIDA/STATE
COUNTY OF J'
OF FLORIDA
_
COUNTY OF d°-c-
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this Zy day of Mo—c, & , 20_U by
this Zo day of h . 20 11 by
dt,cr-',iS 5AmmonS
ClC('�lS" SHrrlM64
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary Public- St to of FI da)
(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
;P °"% CHRISTINE S. ENGLISH
Commission No. fE�s� �� * ej4I)MYCOMMISSION 1EE8592
EXPIRES: April 4, 2017
°.`: " •, `'� CHRISTINE E. ENGLISH
4Commission No.EEcf'3 1/,dd'y * al) MY COMMISSION # EE 85928
sem, EXPIRES: April 4, 2017
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Fl°P\O Bonded Th Budget Nota s
Fly Thru Budget Notary Seat
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