HomeMy WebLinkAboutBUILDING PERMIT APPLICATION.PPUCABLE INFO MUST BE COMPLETED FOR APPUCATIONTO BE ACCEPTED
Date:
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: 56b7-5 Mcck_cl ouJ
Legal Description:
Property Tax ID #: _3LtZS ` ,rl C -)LP — OZZie — 00c) -- I Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Block No.
659169%P1101 w! w w uc pcl wI mvu unuer Lrns permit — GFlt:Uk an Ln01. apply.
`Mechanical ` Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator y Roof
Total Sq. Ft of Construction:
Cost of Construction: S
Name fz ch
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
Address: gO2S Mec1D�Ji� < �-�
City: &ff . Sr✓ L, cG' State: ,:C,
Zip Code: Legs c?Fax:
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: Curtis Sa-mmon
Company: C,usmym Lr 5tisfems 1ivc,
Address: t! l S S E 91 i I 1 aP -It) Dr
City: Po 2-7 ST LAC1� State: FL.
Zip Code: 349Sa Fax: q7; 33S ) �S
Phone No. 7'71 33,5-3Q2
E -Mail: CuSt4tr cu sy co ) -r,m_
State or County License: U C 0 5 1910 She
If value of construction is 2SWor more, a RECORDED Notice of Commencement is required.
5UPPLEMEN IAL CONS I RUC I ION LIEN LAW INFORMA I ION: i
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: I
i
Zip: Phone:
1 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
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.
Signature of Owner
as Agent for Owner
STATE OF FLORIDA
COUNTY OF �2` ,C. U C` I" l✓
The for oing instrument was acknowledged before me
this day of _�y A -Q-, , 20 1 -lby
Signature of Con
STATE OF FLORIDA
COUNTY OF St L t/
The forgoing instrument was acknowledged before me
thisZ3 day of JuCx-e— , 20 t Z by
- eurbs 14mM62YlS" CrurM 5 srlmmon 5.
(Name of person acknowledging ) (Name of person acknowledging)
(Signature of Notary Public- State of FIVda )
Personally Known OR Produced Identification _
Type of Identification Produced
Commission No. � 6 0 5nr � 76
Revised 07/15/2014
(Signature of Notary Public- Stat of Flori
Personally Known OR Produced Identification
Type of Identification Produced
CHRISTINE B , m i
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7 EXPIRES: April 4, 2021
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