HomeMy WebLinkAboutBuilding Permit Application (2) .,PPLICABLE INFO MUST BE COMPLETED FOR APPLICATIORTO BE ACCEPTED `_
Date: S.ohoxsr Permit Number: � 10- -0
I - -
Building Permit Application
Planning and Development Services
Building and Code Regulation Division ,
2300 Virginia Avenue,Fort Pierce FL 34992.1
Phone: (772)452-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address: re Ae
Legal Description:
Property Tax ID#: iJ JY2`�- $00-00 l Q- 00o -D Lot No.
Site Plan Name: , Block No.
Project Name:
Setbacks Front Back: _Right Side: Left Side:
i
L/ /03.r &/fes- 3"rk C/A)75e o /•r Sem
Acid Itio nal wor o e pe Orme under tis perm t—c eck all thatappy:
/Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction;$ y ° ! utilities: ,_,_Sewer _Septic Building Weight:
Name lel c*ori, , Iia rte__ Name: ...._ C(Art t 5 sojyn_rn ern .5
Address:—.1% 19 .oma. Ce.�c _ Campany:._.('us-rbtrtLr'5�_Sfems
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city: State: �G Address: l le 15 -
Zip Code: 3g�� Fax: City: .raQ-T L Lycie
Phone No. 7Y ��9- f.'' Zip Code• _ 54 Q�5Z Fax:_q3a J.3 l
E-Mail; Phone No. 77 3,5 -323'
Fill in fee simple Title Holder on next page(if different E-Mail: C r 1
from the Owner listed above) State or County License: I CP C 0:5 I 10 - 54oAe.
If value of construction is2 oWor more,a RECORDED Notice of Commencement is required.
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"DESIGNER ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: _ Address:
City: Stater City: State:
Zip: phone:_ Zip: Phone:
FEE SIMPLE TITLEHOLDER: _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 Count makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with an Y applicable Home Owners Association rules,Wows 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 Building Codes and St..Lucie County Amendments.
The following building permit applications are exempt from yndergoing 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 sof 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 recorMR yourrecur ' Notice of Commencement. .17
'Signature of Owner/Agent/iessee Signature of Contractor ucerlse Holder
STATE OF FLORIDA STATE OF FLORIQA
COUNTY OF COUNTY OFufz,
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this -_- day of_4g .20y_1' by this day of_ eef-' __ w .20 _15 by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary YlUblic- to of Florida) (SignSture of Notary Pu lic-St of Fldhda)
Personally Known v OR Produced Identification _ Personally Known OR Produced Identification
Type of Identification Produced' Type of Identification Produced
p SP"Y .41 01-IRISTINE CHR1977NE B.EN(iLfSH
Commission No. EJ �7 y * *I�YCOMt11S$i0N# � t,1 �q�IMISSION#EE850294
mission Na.
EXPIRES;April E EXPIRES:April 4,2017
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REVIEWS FRONT ZONING. ' SUPERVISOR- PIANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW' REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED `
DATE
COMPLETED
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