HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE NFO M rBEC OMPLETED F0 >PLICATIONTO BE ACCEPTED
Date: Permit Number: l�
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: �, 0z
Legal Description:
Residential
Property Tax ID #: d V Lfgl' Coro OrD Lot No._
Site Plan Name: Block No.
Proiect Name:
Setbacks Front Back: Right Side: Left Side:
aitionai worK to De pertormea under this permit— cheCK a
_Mechanical _ Gas Tank _ Gas Piping
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 37 o
_ Shutters , Windows/Doors
_ Generator _ Roof
Sq. Ft. of Ei,rst Floor:
,r
Utilities: _ S'e r _ Septic Building Height:
�•Addfess��;y.3`o� `�IN�,di,. C`�� `lX/a,c�
City:,:,•:, o c C� State: r(_• .
Zip Code: Fax:
Phone No. 'J964 9�Y
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name:._ _ _...,Cur tt.5, - •So_ n m on S
5Nsfews
)A1C.
Address:
Dr
City: POP-- ST UC1_
State: FL.
Zip Code: 34 9,%b Fax: q7a
339i-) U 9
Phone No. 77d_ 336- ~3231
E-Mail: (LutbLjc sus y C-o ) -6m
State or County License: Cfl C 05 18 /0
- StLtz '
If value of construction is 2+9Cror more, a RECORDED Notice of Commencement is required.
IGNER/ENGINEER:
Name: _
Address:
City:
Zip:
Phone:
Not Applicable I MORTGAGE COMPANY: _ Not Applicable
Name:
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
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
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 cerise Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF ��
COUNTY OF 'Q�
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this d Y day of ,D P-,& , 20,Z�l by
this A?d_ day of Pek AefL . 20.,�S/ by
Z'Z'LTI� '12ol7ur
�
L�;W
r%��/cS e`�62y_
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary Public- State Florida) ""''
,yr
(Signature of Notary Public- Statelliorida )
Personally Known (// OR Produced Identification
Personally Known OR Produced Identification
Type of Identification Produced
Type of Identification Produced
p `' "••'• �° CHRISTINE B. ENGLI
Commission No. C1 s�,��Y I), MY COMMISSION#EE85
H "'•. 'c CHRISTINE B. ENGLISH
!� y COMMISSION # EE 859284
&mmission No. �C ����L ��EXPIRES:A ril4
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EXPIRES: April4, 20
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REVIEWS w;,.
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014