HomeMy WebLinkAboutBuilding Permit Application 41PLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
01 R E C U.-D SEP 141015
....... Building Permit Application
Planning crud Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 3498Y
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential V/
PERMIT APPLICATION FOR:
Address: 12i'119
Legal Description,
Property Tax I D Lot No.
Site Plan Name. Block No.
Project Name:
Setbacks Front Back: Right Side-, Left Side:
It"lona work to tie pertormed undere is permit--check all that apply:
"tion
Ana
—Mechanical —Gas Tank Gas Piping r Shutters Windows/Doors
Electric Plumbing Sprinklers Generator Roof
Total Sq.Ft of Construction- Sq. Ft.of First Floor:
Cost of Construction:$ --- d_t10 Utilities: —Sewer —Septic Building Height:
Name
_ Name: &trtis ScLwart on,5
Address: , '
6, Z/
Company: CusmA
City: S . T
State: Address:- t�15
Zip Code:- eZ. f.5'�- Fax: City; Poel 5T Lkc_rC__ state: f
Phone No, Zip Code, � Fax: `77,_335 04N
E-Mail; Phone No. 77,2
Fill In fee simple rifle Holder on next page(if different E-Mail: - Cufoor S�l V_ og em
from the Owner listed above) State or County License: u=)RIQ s4ale
If value of construction isZSOtror more,a RECORDED Notice of Commencement is required.
a DES IGNER/EIIIGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name.• Name:
Address: Address:
City:_ State: City: State:
Zip: Phone: Zip: Phone;
PEE 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 Coun 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 1 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 rooms and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice c►f 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 recorftg your Notice of Commencement.
Signature of Owner/Agent/lessee Signature of Contractor License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF a -�� COUNTY OF �(,(',r�
The forgoing instrumeni was acknowledged before me The forgoing instrum nt was acknowledged laefore me
this day of205 by this day of 20Lj,by
u lr-I-t S :-,'�M pro rIS
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notar7OR
.Sta of Florida) (Signa''ture of Notary Public-State lotida)
-Personally Known 7 Produced Identification Personally Known t/_ _/ OR Produced identification
Type of identification Produced CHRIS JUE 0, 1, Type of Identification Produced.
Commission No.,?�G LfS�,eg�l , �)My COMMISSION 0EEA592�1Commission No. �����or�y * MY COMMISSION 9EE 4
- EXPtAFG:April C 2017 ` EXPIRES:Alid 4,201
Imo" "':1,e• 9ended TnN Budget NdlUN Seal s �,� �a Bonded Thm tludge!llom$
REVIEWS FRONT ZONING SUPERVISOR PiANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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