HomeMy WebLinkAboutBuilding Permit Application.PPLICABLE INFO MUST BE COMPLETED FOR APPLICATIONTO BE ACCEPTED
Date: x55- # -/'7 Permit Number:
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:
Legal Description:
Property Tax ID l;:
Site Plan Name:
Project Name:
Setbacks Front
Building Permit Application
Commercial
'f SI 1- 11 oed 1-C7/
Back: Right Side: left Side:
Z' /Ac_ fl --r L1kc- Is,S ee-f (,o(^ ri,<- o " '
Residential
Lot No.
Block No.
_iviecnanical _ uas i anK _ uas raping
_ �,wuvi — ..II I.,VW., � �Ww'
_ Electric _ Plumbing _ Sprinklers
_ Generator , Roof
Total Sq. Ft of Construction:
Sq. Ft. of First Floor:
Cost of Construction: $ V/ 10 Utilities: _ Sewer _ Septic Building Height:
Name J¢" N ('.o lz1Aar\.
Name: Curt,ls SSa-moron S
Address: 100 h1L(& Ra, 1),q
Company: CAA5T&,rM A r 515tuls�luc-
City: _3144x.- &" State: rt
Address: Ile l S S6 T i I (a r�prn D,-
Zip Code: 34Q5q Fax:
City: PoP7 ST U0,f_ d State: �L
Phone No.
Zip Code: Ali qs� Fax:� 33S 19G� F
E -Mail:
Phone No. 77,2 33.5 332
Fill in fee simple Title Holder on next page ( if different
E -Mail: C -U stc� Ir V s,.o ) -(.c�.
Cfl C 0 5 I R I O _She
from the Owner listed above)
State or County License:
If value of construction is 2SWor more, a RECORDED Notice of Commencement is required.
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SUPPLEMEN I AL CONS I RUC I ION LIEN LAW INFORMAIION:
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:
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Coun 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 exemptfrom undergoing a full concurrency review: room additions,
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessory uses to another non-residential use
WARN ING 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 recolyding your Notice of Commencement.
C7� -
s
Signature of Owner/tessee C�on�tractor Agent for Owner Signature of Contra r/License Holder
STATE OF FLORIDA /
COUNTY OF
The forgoing instrument was acknowledged before me
this o"' day of Atzf 20/7 by
-curbs �igmmvns'
(Name of person acknowledging )
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this _Y day of 41,fa 20 17 by
Chu ►ZT 15 sn rvl tn'10 n S
(Name of person acknowledging)
(Signature of Notary Public- State of FI a) (Signature of Notary Public- Stat oe' f Flor'
/
Personally Known ✓_ OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
/ C //,,// YP s asy •r�. CMk15Titi+ .,t
Commission No. U1 05� 7b a �h
Bmission No. o
EXP RES:Apd- 2021
o►ti Ga�O.eTi�uludp�tr�alays.Mns t ......, -
Rei°ised 07/15/2014 * * MYCMASSON111MORM
MMM April b 2121
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE I i
COMPLETE
INITIALS
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121
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