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HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COW "-TED FOR APPLICATION TD BE ACCEPTED Date: — SCANNED Permit Nu er: BY St. Lucie County 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 639 Property Tax ID #: Ol,?©`Mp Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: L1 ke- /Z-r 13se-r Aaamonai worK to De pertormea under tnis permit— check all that apply: _Mechanical _ Gas Tank _ Gas Piping _ Shutters — Windows/Doors _ Electric _ Plumbing _ Sprinklers _ Generator — Roof Total Sq. Ft of Construction: Sq. Ft. of First Floor: Cost of Construction: $ ,� �� �l Utilities: —Sewer _Septic Building Height: Name/&&/V.&Z&Aa-, zu,�a Ate. Name: Cur•tts ' aO- ninon S :Company'r'('uSTern i �u S fe�ns )lV c Citji:. 'A" State: P�1': State: rig -Address:' '.:1� 15.- S E �1 i I (ciao Q reen Dr Zip' Code: Fax: City: 'Poi2z Si LtiC l� State: L. Phone No. Zip Code: 349S9-) Fax: 2 7a 335') U R E-Mail: Phone No. 77d- 33;5 -3a32- Fill in fee simple Title Holder on next page ( if different E-Mail: Costa lr su -, V G.o ) -(,M from the Owner listed above) State or County License: Cfl C 0 5 ) 9 !O Soo e If value of construction is 259Uor more, a RECORDED Notice of Commencement is required. It. 'a DESIGNER/ENGINEER: N Name: Address: City: State: Zip: Phone: FEE SIMPLE TITLE HOLDER: _ Not Applicable Name: _ Address: City: _ Zip: Phone: MORTGAGE COMPANY: _ Not Applicable Name: Address: City: State: Zip: Phone: BONDING COMPANY: Not Applicable Name: _ Address: City:_ 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 u 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/L cense Holder STATE OF FLORIDA ,p , STATE OF FLORIDA COUNTY OF COUNTY OF � The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me this .47 day of 69 t ,20_Yby this —Zday ofl�/, kaj .20/y� by CIU_ffs ��Irnmon S- OlfrUlS S/4-M14001 (Name of person acknowledging) (Name of person acknowledging) (Signature of Notary ublic- S e of Florida) (Signature of Notary ublicyS e of Florida ) Personally Known ✓ OR Produced Identification Personally Known t// OR Produced Identification Type of Identification Produced . Type of Identification Produced PAW p *?� Pu"c *CH No. RIMNE B. EG2 MY COMMISSION # EE dOj ,R• pVBl bmmission No.Eef L WRIONE B. E NGLIShCommission 59MY COMMISSION# EE 859 EXPIRES: April4,2)1 m�qr \OQ,Nj7 7 EXPIRES: April 4, 2017 OP Fl fIV1 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE RECEIVED DATE COMPLETED Rev. 7/2014