HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COM_-ti 7ED FOR APPLICATION TO BE ACCEPTED
SCANNE-� Kermit Number: BY mo - 0-3 5
St. Lucie County
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
PERMIT APPLICATION FOR:
Address: � 0 ef?
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name:
od6P6 - 000
Setbacks Front Back: Right Side: Left Side:
Residential
Lot No.
Block No.
s�v
worK to De pertormed under this permit— check all that a
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction:
Cost of Construction: $ rr-Q "
Name ,Z'e L
Sq. Ft. of First Floor:
_ Windows/Doors
Roof
Utilities: —Sewer —Septic Building Height:
Address: gU�P3 W-z&& d4,d-- t
City: - �, State: fL
Zip C de: M'00'7 Fax:
Phone No. J/6 D/- &?p •.
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
,Name:(t'i ' .;CurtL'S'.`•SGL.Vi' rn0n S
fConipany: -(',A, -!roril: '�i� S�sfems ��G
`Address: 14IS 'S-C Vi 16a. Q rein Dr
City: P4Q.T ST IkCIe_ 0 ItiState: F'L.
Zip Code: 34 R,Sb Fax: q7a 33Y ) 94 R
Phone No. 77d 33,5 ~3d,3 2-
E-Mail: CUSfiQI(- S!s V G.o )-('C-M
State or County License: Cfl C 0 5 I R 1 D- S40 e'
If value of construction is?SBWor more, a RECORDED Notice of Commencement is required.
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:
Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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
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/ gent/ Lessee
Signature of Contractor/cvcense Holder
STATE OF FLORIDA f/�
COUNTYOF
STATE OF FLORIDA
COUNTY OF �
�(G�
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of -li , 20 _Z by
this day of . 20 ,by
61P LIT a J~nOW—f
(Name of person acknowledging)
(Name of person acknowledging) f
(Signature of Notary Public- to of Florida)
(Signature of Notary Publi - State Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification Produced Y P
Type of Identification Produced
.: •'••. '�
MY COMMISSION # EE
Commission No. EE��a��y *40:EXPIRES: April4,
USH O :PUB CHRISTINE B. ENGLISH
8 Zt ��"� �• ��°
�4nmission No. ��,5%Z�y * �I)tifYCOMMISSION#EE85928
017 EXPIRES: April 4, 2017
OF FLOOD Bonded Ttua Budget Notary
Serybi %rEOF F7dP\o� Bonded ThN Budget Notary SeNic
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 712-014