HomeMy WebLinkAboutBuilding Permit Application PPUCABLE INFO{MUST SE COMPLETED FOR AriPLICA ONTO 13E ACCEPTED
Date: - -1 /-So
Permit Number• 0
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierre FL 349a
Phone:(772)462-1553 Fax:(772)452-1578 Commercial Residential
[Fi—RM—IT—APPLICATION FOR: v r
Address:- 9&34:;'
Legal Description: -
Property Tax ID#• 53da -Suc)
Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
/ti&s-rcl- S'urfc' I-Me lzPr L11cc 3,Tan Ir^se,r eAA175f_ 0u! r1j6'11
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Additional%Ofk to be perfor-m-eff under this perm -c ac a a appy:
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:$ 7 2 y a " Utilities: —Sewer —Septic Building Height:_
Name�/7f?L4 , LoLjOS /Y ae bOIJ Name: L'urti-s Sa.wpnon s
'Address: Company: Cag-rom A i t Sus+ems JIU Q
.city: I3 eCI Fo,-d r�1S S�.
ty' State:_N Address: t le l S 9J' I ba P.Q r n Dr
Code: 13 Q,4 Fax: City: fol?"C ST Luc Ems. __State: rL.
„x ne No. q IQ- 3 V Zip Code: �251 Fax: 335 )
ail: Phone No. 771. 336_-393
F'
Fill in fee simple Title Holder on next page(If different E-Mail: �us'�a�r- cu rt w a.d 1.��•.
from the Owner listed above) State or County License: C-A C 0518 10 - S-UP-
If value of Spnsftetion is 2S9dor more,a RECORDED Notice of Commencement is required.
7 00
DESIGNER/ENGINEER: _ Not Applicable MQRTGAGE COMPANY: Not Applicable
Name- Name: --
Address: Address:
City;�..,. - - State: City: State:
Zip: Phone: Zip: Phond:
FEE SIMPLIE ttTLE MOLDER: _Not Applicable BdNDING COMPANY; Not Applicable
Name: Name:
Address Address,
City: City:
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 peimli;.
St.Lucie Cour>ty 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 rules,bylaws pr an covenants that may restrict or prohibit such
structure.Please consult with your Home Owners Assodatwn and renew your deed r 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 Buildipg 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,waft,signs,screen rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your faildr+e to Record a Notice of Commencement may result in your paying twice for
improvements to your property.A Notice of Commencement musk 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 HolderSTATE OF OF FLORIDA ST'A'TE OF FLORIDA
COUNTY OF 7 i•-U C I e COUNTY 01=_--. 5-r Go C-i C
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of— .20_ by this day of ,. - 20 by
Ur +l S J�isF+n Yf�p(� I.LLAfris #rnrn�n �.
(Name of person acknowledging) (Name of person acknowledging)
7� �
(Signature of Notary Public-Sia of Florida) (Signature of Notary Public-State ride)
Personally Known / OR Produced Identification Personally Known '/ OR Produced identification
'type of Identification Produced Type of Identification Produced
Commission No. IIY�rEt: �
1) p 17 Commission No. r dPS�'odo� * 4,�i #
hors ,yIRE8:Apd4.2li1
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DAT9
COMPLETED
ev.
Cid: