HomeMy WebLinkAboutBuildinfg Permit application.PPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: r "� "� 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 #:
Site Plan Name:
Project Name:
Setbacks Front
Building Permit Application
Commercial Residential
Jy,Z I/- 7DV-ff73-&0
Back: Right Side:
_Mechanical _ Gas Tank
_ Electric , Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ ' JP
Left Side:
Permit — cnUCK an mm apply:
_ Gas Piping _ Shutters
_ Sprinklers _ Generator
Sq. Ft. of First Floor:
Utilities: —Sewer _ Septic
Name v IL"
Address: Oli/YZE J614, .&j-)
City: P�>L� �` �Ury State: f7�
Zip Code:
r/c- Fax:
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Lot No.
Block No.
_ Windows/Doors
Roof
Building Height:
Name: /CurttS So-mmon S
Company: I,L ii&m A t'r 5� S tins )ti c.
Address: «e IS S E T i I ( o ao_� rwn D,-
City: PO Q 7 S T L]l C« d State: �L
Zip Code: 34 �,2 Fax: _22,1 33S 146 X
Phone No. 771 33,5 -323-2-
E-Mail: C.uSt4Ir, SL,t V ¢o I •r,t-^
State or County License: Cfl C 0 5 )RIO 54OAe
If value of construction is 25Kor more, a RECORDED Notice of Commencement is required.
SUPPLEM EN IAL GUNS I RUC I ION LIEN LAW INFOKMA I ION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State: _
Zip: Phone: j 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 County makes no representation that is granting a permit will authorize thepermit 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 vrith 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 recording your Notice of Commencement.
'1
Signature of Owner/lessee Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA/
COUNTY OF J'-( 4U(�% e
The forgoing instrument was acknowledged before me
this day of "kr,,20 i '7_b<<
u
(Name of person acknowledging )
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this d I day of 20 i 7 by
&rLrl S Stl Mvv�vrt S
(Name of person acknowledging)
(Signature of Notary Public- State of FI a) (Signature of Notary Public- Stat oe' f Flori
0 �
Personally Known �_ OR Produced Identification Personally Known OR Produced Identification _
Type of Identification Produced Type of Identification Produced
CHR
Commission No. B�ft�Ifimission No.
* * WCOM ISSMS sellas"
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J, � EXPIRESApra � t, 2021 r .' `�
Wnftd nw Wdod th" moos �Y .•' • :ZF+ EpG�15fi
Revised 07/15/2014 * * MyCWMISSl0N#G08=6
fer EXPIRES: April 4, 2021
REVIEWS FRONT ZONING SUPERVISOR PLANS ' VEGETATIONSEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
1
DATE I I _
COMPLETE
INITIALS