HomeMy WebLinkAboutBuilding Permit Application.PPLICABLE INFO MUST BE COMPLETED FOR APPUCATION'TO BE ACCEPTED
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Date: �� � ) / ! 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:
Building Permit Application
Commercial Residential
Property Tax ID #: i�. 7IlWj' -MC L Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
t 11Je /I,r L11c y� IS—,Seer C/,)4 rS(- Jc- /,,h�-
U141VII01 WIrvIw w LOC PCIwIflICU unuci calla PCI IML—u1C4-R au Ulal apply.
_Mechanical _ Gas Tank _ Gas Piping _ Shutters — Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ _ Roof
Total Sq. Ft of Construction:
Cost of Construction: $
Name o -
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
Address:
City: t State: L
Zip Code: JV f42.1 Fax:
Phone No. 4214
E -Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: Curds SSammon
Company: CAksTnrh Lr 5!4sfeims kic,
Address: t! IS S E 91 r 1(Qo- Q r&n Dr
City: *Vo Z T L4 C I C- State: FL
Zip Code: 34 qS-2 Fax: '77a 33s- ) 46 X
Phone No. 77.z :33,5 J aYI
E -Mail: C-Usto 1r s4 cy CSO
State or County License: CA C 0 5 )R1D She
ff value of construction is 2SWor more, a RECORDED Notice of Commencement is required.
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SUPPLEM EN IAL CONS I RUC I ION LIEN LAW INFORMA I ION:
DESIGNER/ENGINEER: Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name: j
Address:
Address:
City: State:
City: State:
Zip: Phone:
Zip: Phone:
i
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: _Not Applicable
Name:
Name:
Address:
Address: j
City:
City: j
Zip: Phone:
1
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 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
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 rec ,[ding your Notice of Commencement.
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Signature of Owner/ essee/Contractor as Agent for Owner Signature of Contrac r/License Holder
;
STATE OF FLORIDA4
r / STATE OF FLORIDA
COUNTY OF � UCI e �f Ltl(/�.
J COUNTY OF
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The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of MAY 20 L-� by this L day of M A• � 20 1 % by
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�u r ti s � f� rn moYl S' (_ CC IZTI S S>41'►'I v►'�v n S
(Name of person acknowledging) (Name of person acknowledging)
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(Signature of Notary Public- State of Fl a) (Signature of Notary Public- Stat of Flori
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Personally Known OR Produced Identification Personally Known OR Produced Identification �
Type of Identification Produced Type of Identification Produced
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0 5� Y b rkE, CHRISTINE B of CJ oC 5 l� CHk►�?u� , }
Commission NO. n1i5510n NO. ha:-:'r.. ••. ;
* * WC0MMiSS10Nt 0.525 6
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Revised 07/15/201 mome
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�`�S�EATURTLE
REVIEWS FRONT ZONING j SUPERVISOR PLANS VEGETATION MANGROVE
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COUNTER REVIEW I REVIEW REVIEW ' REVIEW REVIEW REVIEW
DATE
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COMPLETE
INITIALS
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