HomeMy WebLinkAboutBuilding Permit Application .PPLICABLE INFO MUST BE COMPUTED FOR APPLICATION TO BE ACCEPTED
Date, Permit Number: t --Q1qAl
Buiidiing Permit AppliCation
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 3495.2
Phone.(772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address: . t111 f 6�z. &ZIA2 Aae"',
Legal Description:
Property sax iD#: lot No. — —Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: _Left Side:
i{l�� �ar �1t� `°�► 135���• 61A OSS
11ditionalwork to be performed under this perms -chock all that appy:
—Mechanical _Cas Tank Gas Piping —ShuttersWindows/Doors
Electric Plumbing __Sprinklers ,,,_,Generator _Roof
Total Sq.Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:SSA Utilities: Sewer _Septic Building Height:
Name. Name: Cur�tS St .tmwton S
Address: /o°Ue YJa.P Company: �A�xhzm_ AL r !„S to ms )Lg.,
City: , "lamel State: L- 6, Address: 1!e 15 S i~ 211 Ija.l rwI D,-
Zip Code: C Fax- ` City: &L e State:,'FL.
Phone No. p3' Lao-&5,3 Zip Code: 3455% t=ax: qU 5 )U g
E-Mail: Phone No. 77.7- a� "3;L3'2_
Fill in fee simple Title Holder on next page(if different E-Mail: � cu stq tr<!y cog),r,cam+
from the Owner listed above) State or County License: C fl C
If value of construction is.y6 or more,a RECORDED Notice of Commencement is required.
704
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Namie:
Address: Address: r
City: State; _ City: State:
Zi Phone:_ _ Zip: Phond: --
FEE SiMPLE TITLEHOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: _ City:
Zip: phone: Zip: Phone:
OWNER/CONTRAICTOR 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 Buiidi jig 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 faildre 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. /
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Signature of Owner/Agent/Lessee Signature of Contractor/License Holder
STATE OF FLORIDASTATE OF�U CI� COUNTYOF".
COUNTY O5 i �L?C l.e •- _
F S 7
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this IAI day of =:±*- 20 /f by this_ day of 20z by
r
(Name of person acknowledging) (Name of person acknowledging)
' . .XX
(Signature of Notary Public-Sta of Florida) (Signature of Notary Public-State of rida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced_-.- .11AY� C"am DOM Type of identification Produced
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r My OOMMISSION I EE B598B _••. y 019wi s.Elmo
Commission No. 9��y * I) EXPIRES:April 4,2017 Commission No. �P,��d�y ,k WCOMININOFE
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�� orr� EendeCThru $°M AEXPIRES:April 4,20f
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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