HomeMy WebLinkAboutBuilding Permit Application PiLICABLE INFO MUST BE COMPLETED FOR APPLICATIONTO BE ACCEPTED
Date. X— Permit Number,
IId
Building Permit Application
Planning and Development Services
Building end Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address: J77Y
Legal Description:
Property Tax ID#: w Lot No.nwn
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side; Left Side:
r PC C, 9roA C�A)15f, Ovr
Additional work to be perrormed under this permit–cnaCK 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:$ Utilities: Sewer Septic Building Height:
Name le, Name:_ Crtts ,Sq Lern monZ,
Address, Company: Ca�-r&ea Vr St4SIfemS )IUC.
city.. State:
Address. tWS S& V4 ll ren Dr--
ti J
zip Code- Fax: City: Poer T Lk,-i State:
Phone No. `77,Z &q9W9df Zip Code: �4,55L Fax: q7; 3,5 )U9
E-Mail* PhoneNo.
Fill In fee simple Title Holder on next page 4 if different E-Mail- C_uLstolr c;42
from the Owner listed above) State or County License: C 0 6 1 R 10 _54ake,
if value of construction Is 25WOr more,a RECORDED Notice of Commencement is required.
ro-O
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phond:
FEE SIMPLI 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 Horne 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,l-do hereby agree that I will,in all respects,perform the work
in accordance with the approved plans,the Florida Buiidipg 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 accessary uses to another non-residential use
WARNING TO OWNER.,Your failure to Record a Notice of Commencement may result in your paying twine 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 fiinancin& consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
Olt—
Signature of owner/Agent/Lessee Signature of Contractor/License Holder
STATE OF FLORIDA, STATE OF FLORIDA
COUNTY OF 'T L U c If COUNTY OF—;.
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this t day of ,20 AS by this, day of 4&4 J 20/1, by
( .U r f 1 S' :50m Y}1 U l.^4th T T S r rare C.
(Name of person acknowledging) (Name of person acknowledging),
(Signature of Notary Public-Stat&bf Florida) (Signature of Notary Public-State of ncla y
Personally Known OR Produced identification Personally Known OR Produced Identification
Type of identification Produced 0 Po Type of Identification Produced
�,. ., MYCONiMiS8i0Nr� Y
Commission No. c� � �� ' all:•••• ► g l7i3GlIB
) EXp1RE9.Aptii4,2017 Commission No. ��6P9�dr��` � �>+1YC0>tgi�lONiEE
"arf 8er�0ed fi�a dud�at N 1 S f,� saEX IRE$:Aprli 4.201
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVEI] i 7
DATE
COMPLETED
ev_