HomeMy WebLinkAboutBuilding Permit Application .'?Puc*g FOM ST COMPLETED FORAPPLICATIONTOBEACCEffED
I ('fDate-, Permit Number;
Buildin.g Permit Application
Planrnih,q and DeVeloprnellt Services
,Building enc!Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982'
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address: qffV_7� A
Legal Description:
PropertyTax[D#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back; Right Side: Left Side*
Ll 1,
rIt�ona
MorktobeperTormed underthIS permit—Chgck all that appy:
— ecanical Gas Tank Gas Piping —Shutters Windows/Doors
Electric Plumbing Sprinklers Generator Roof
Total Sq.Ft of Construction: Sq. Ft.of Fir5t Floor:
Cost of Construction:$ Utilities: _Sewer _Septic Building Height:
Name E/' Ay 6M'6g'4(2 Name: etcrtts 'SamrofiS
Address- d1.74� -4" AlAlt Company: Cat-r,„ m A.Cr
City: State, rl, Address: va. ar -
Zip Code: — Fax: city.
Pen S-T-LkckcState-
Phone No, Zip Code, 1A 55% Fax: '72; 335 I J�,
E-Mail: Phone No. 77,2_� -3a3
Fill in fee simple Title Holder on next page(if different E-Mail: C.U AL it ”-u,, v C'D
from the Owner listed above) State or County License: C'Aco� ?81.0
if value of construction is2SOCror more,a RECORDED Notice of Commencement Is required.
DESMIGNERIENGINEEIR: Not Applicable MORTGAGE COMPANY: ^Not Applicable
Name: Name-,
Address-, Address:
City: State: City: state;
Zip: Phone-, Zip: Ph6ne:
FEE SIMPLE TITLE HOLDER: i 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 Countymakes 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
ifi accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments,
The following building permit applications a're 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 Recordii 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 recur vour Notice of Commencement. lei
Signature ofowner/Agent)imee Signature of Contractor License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
,.thisL Vday of 20/,�, by this /_�Iday of 12.d& 201T by
_j
(Name of person acknowledging) (Name of person acknowledging)
-r(signature of Notary Public-St A ofFlorida) (Signitture of Notary Public-State P"Jelcla)
Personally Known k1 OR Produced Identificati6n Personally Known OR Produced identification
Type of Identification Produced... Type of identification Produced
CHREMEe. MUSH
EM
MyMMMI0N1EE8,1 _G0MW$8I0N#EE88284
Commission No- lfrnmis�ion No,
EXPIRES:AprD4, 17 EXPIRES:Aptil 4,9017
REVIEWS FRONT ZONING SUPERVISOR, PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
OATE
RECEIVED
DATE
COMPLETED
Rev.7/2014