HomeMy WebLinkAboutBuilding Permit Application ..d?PLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
APP 9 0
Building Permit Application
Planning and Development services V
Building urtd Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 3498�'
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address:
Legal Description:
Property Tax ID 09^ 0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
L
Additional worpo De pertormed under this perm tt--choci(all tat appy:
,_,,,Mechanical —Gas Tank Gas Piping Shutters Windows/Doors-
Electric Plumbing Sprinklers J Generator Roof
Total Sq.Ft of Construction: Sq.Ft.of First Floor,
Cost of Construction:$ _3777 " Utilities: Sewer _Septic Building Height:
Name I A
0- Name: Curtis .50_Mmon_5,_
Address: !Z�taa l� R * FA Company: g
A' 5qsfgm5 )iuc_
State:..i= Address- lfe IS da e z.!2 rAf a Dr
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Zip Code: st�q_ Fax: City:.Pp 9
,a �T Lketc-
State: L.
Phone No. Zip Cade: 345-% Fax: qu, US'l
EE-Mail., .No. 77.2
Fill in fee simple Title Holder on next page if different E-Mail: C4"t T 9 W V 6-6
from the Owner listed above) State or County License:
If value of construction is 2SWor more,a RECORDED Notice of Commencement Is required.
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: - State: _ - City: State:
Zip: Phone; zip: Phond:
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 0,,gners Association and review your deed for any restrictions which may apply.
In consideration of the granting of this rege ested permit,i do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Buildilpg 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 our Notice of Commencement.
Signature of Owner/Agent/Lessee Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF7 l-- C l•8 ___--_- - . COUNTY OF_;._ 5 i UP c r e
The forgoing instrument was acknowledged before me ,The forgoing instrument was acknowledged before me
this�day of 410016 20 fS by -this day of 20 1.5 by
( .Ur 4m rri onS --- 1�4e Tls Z-4 0/—?
(Name of person acknowledging) (Name of person acknowledging)
2 le
(Signature of Notary Public-StatjVof Florida) (Signature of Notary Public-State of rida)
Personally Known OR Produced Identification Personally Known '� OR Produced Identification
Type of Identification Produced_- .*AY J11A.�MI g RALSH Type of Identification Produced
�.;..
MY COMgISSION t EE 65.928
Commiss;on Nv- �8 5�d�'Y *al) IixP1RES:Apal4,2017 Commfsslon No. o°sr/da/y d�H1s1N�8.l:Ns�Lll3
aeneea Thm su4let tiotan sem * lUY COlNIAI3310H f ff
oe� IRIS:April 4,got
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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