HomeMy WebLinkAboutpermit application.PPUCABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: 6 lq 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 Commercial Residential
PERMIT APPLICATION FOR:
Address:
Legal Description:
Property Tax ID #: =sL7 ry��U Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
01re )Zr �,lltc_ (/'ran 1�Sc-ef pnSe-
_ Gas Tank _ Gas Piping
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: S � 3 7S
Name
Block No.
_ Shutters _ Windows/Doors
Generator Roof
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
Address: Jw 4(j .!v A �e�
city: A"Jf ei- n' 'W_ State: f�
Zip Code: J 10;z- Fax:
Phone No. %%aC
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner fisted above)
Name: Curtis SSamrnon
Company: C)As-rpm Lr SsiS to ins )>u c,
Address: tk IS S E Til(aQo_ Q ren D,-
City: ST L4C 1State: FL.
Zip Code: 34Fax: `77; 33S 1 t6
Phone No. 772 335' -3a3'2-
E-Mail: C.uSt4Ir cti ao ) - C' M
State or County License: Cfl C 05 1? !D -She
If value of construction is 25Kor more, a RECORDED Notice of Commencement Is required-
SUPPLEMEN IAL CONS I RUC I ION LIEN LAW INFOKMAI 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:
Address:
City:
City:
Zip: Phone:
i
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 recardiniz your Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner
STATE OF FLORIDA
COUNTY OF SY 4 U e l e
The fing instrument was acknowledged before me
orgo
this ,� day of 9t41c , 20 Z-Zby
Signature of Co
STATE OF FLORIDA
COUNTY OF S'�f Z v
The forgoing instrument was acknowledged before me
this Z0 day of 20 / % by
el
- eurbs �nf7imorlS' LrzrI s SnmmorA S
(Name of person acknowledging I (Name of person acknowledging)
- �11a_4
(Signature of Notary Public- State of FI e
a )
Personally Known OR Produced Identification
Type of Identification Produced
Commission No. U1 6n 0 5� � qC
Revised 07/15/2014
(Signature of Notary Public- Stat of Flori
Personally Known ' OR Produced Identification
Type of Identification Produced
CHRISTINE El QWimission No. VI (2
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