HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONAll APPLICABLE INFO MUST BE COMPF'_ __'eD FOR APPLICATION TD BE ACCEPTED.
Date: SCANNED Permit Numbe r
BY
St. Lucie County
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 3498�'
Phone: (772)462-1553 Fax:(772)462--1578 Commercial Res'idential
PERMIT APPLICATION FOR:
Address:
Legal Description:
WNW40,1911=61
Property Tax ID #: Aw _61��o _411a_�Wlo 7 Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
- I"-(- !!1A11S1_ OVr
—GasTank
-rl( 1,�/
— Gas Piping
Shutters
Block No.
Windows/Doors
- Electric — Plumbing — Sprinklers — Generator Roof
Total Sq. Ft of Construction:
Cost of Construction: $
Sq. Ft. of First Floor:
Utilities: — Sewer — Septic Building Height:
Name
-Ad&
,es�i X,
�'Citv,,,", IOdil 1j'X state: c��
Zi p C od e Fax:
Phone No.— AF�2 -,?ea 0 0.
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: curtts so-mmoti-5
(o
P_ Q nee & D r -
city: 's-r- _ U,� .. Ile State: rL.
ZipCode: 342SZ — Fax: _'77a J 3S_ I U 9
PhoneNo.— - 77.2 53,5--3Q-L
E-Mail: ttlsto_� If' 01W %, V a 0 ) -I', M I I
State or County License: C-AC05)RIO -S4CLte,
if value of construction Is 258Wor more, a RECORDED Notice of Commencement is required.
It. It.
DESIGN ER/ENGINEER: — Not Applica
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 certifV 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 ermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rule�, bylaws or an9covenants 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 ro6ms and accessory uses to another non-residential use
ARNING 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
Wcommencing work or recording vour Notice of Commencement.
$�4
Signature of Owner/ Agent/ Lessee
Signature of Contra ctor/LYcense Holder
STATE 01 ILORID!Ak& _QL,
STATE OF FLORIDA
COUNTYOF '&
COUNTYOF
The forgging instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this _-,L day of kJ&_ YY 20_/ 5- by
this �,� day ofQ)-6-7_-) 20 1�56y
611f
S
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary Pulodic- State Florida
(Signature of Notary Public-fState l6ridi
Personally Known OR Produced Identification
Personally Known /��OR Produced Identification
Type of Identification Produced—
Type of Identification Produced
'�Ay Poe, cHRISTINIE 8. ENGL
Commission No. MY COMMISSION# EE
April 4, 2017
oky p1la.
ISH CHRI917INERENGLISH
P 'Q MY COMMISSION # EE 8592E
8 5ftm mission No.
EXPIRES: April 4, 2017
EXPIRES:
Ir BondedThndB0PtNotarY8eMCet
Bonded Thrugudgef Notary Servio
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.7/203.4