HomeMy WebLinkAboutBuilding Permit Application.?PUCABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: S of S _/ %
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
)ERMIT APPLICATION FOR:
Permit Number.
Building Permit Application
Commercial Residential
address:
Legal Description:
Property Tax ID #: 1hd- X _Oldl– ecl J Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
_Mechanical
_ Electric
9 fi' Cc:=
_ Gas Tank
— Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ j 0 0 oa
Name
_ Gas Piping
_ Sprinklers
IA
_ Shutters
Generator
Sq. Ft. of First Floor: _
Block No.
Windows/Doors
Roof
Utilities: _ Sewer _ Septic Building Height:
Address: SllciF mho �rt� ��"
City: Fc,/Lt P� I,c state: FL-
Zip
LZip Code: _3 q � 5- / Fax:
Phone No. Tia " X094
E -Mail:
Fill in fee simple Trtle Holder on next page ( if different
from the Owner listed above)
Name: Cutts Sammon
Company: C'us-re m Lr r 5!4 s f e ms N c,
Address: Ile [ S S E T r 11rAm Dr
City:yo z ST LAc « State: FL.
Zip Code: 34 Fax: 'i7a 33S 1 �t6
Phone No. `17� 3� S 3 23 2
E -Mail: Cki Sto,r o)
State or County License: CAC 0 5 )X 10 Se
if value of construction is 25Kor more, a RECORDED Notice of Commencement is required.
SUPPLEMEN IAL CONS 1 RUC:I ION LIEN LAW INFORMAI ION:
DESIGNER/ENGINEER: _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
Address:
City: State:
City: State:
Zip: Phone:
Zip: Phone:
i
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address: i
Address:
City:
City: I
Z`1 P: Phone:
Zip: Phone:
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 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 re c , ding your Notice of Commencement.
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Signature of Owner/lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
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STATE OF FLORIDA�r STATE OF FLORIDA
XY COUNTY OF �f L 0 -2.
COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 0 SS day of m Ai 20 I? by this day of M AY 20 17 by
Liu r tl S �� m mon 5" u tZ Tl S sn VVI M0 n S
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public- State of Fi a) (Signature of Notary Public- Stat of Flori j
Known OR Produced Identification i
Personally Known OR Produced Identification Personally
Type of Identification Produced Type of Identification Produced
Commission No. 616 CHRISTPE B El QWimission No. ►�'-°?
* * MY COMMISSION / 052545m' n� c:
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Retiised07/15/3014 . ExPIREs: AprY 4, 2021
REVIEWS FRONT ZONING SUPERVISOR ' PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
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INITIALS