HomeMy WebLinkAboutBuilding Permit Application ..iPPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO DE ACCEPTED
Date- 10- 50- tf2 - Permit Number: 13-11- Mot
Building Permit Application
Planning and DevelaprnentServices
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 3458,2
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address: SCQ)1-1 �fW
Legal Description:
Property Tax ID#: -"-I U-D Lot No.
Site Plan Name- Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
I-11-r JJke-- ell-ASS- og- /Seer"t"
AdclitionalWo-rK'to-bOp-e-rformecI underthis permit-check all that apply:
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:$ Utilities: —Sewer _Septic Building Height:
Name __�. Cab r fy-1 Name: Curtis So-A.MVDon .5
Address: T�:,L k -1 NV.V-,GLQ,(00t I Company- ,Cd en2m -AU-- 5LJS+eMS )AJQ
City: por - State-_F-L, Address: 'V (cm,�-Q njv- A D
U zi
Zip Code: Fax-- City- oe--r ST.Ucke- State--LL
Phone No 17-1 SS rf 51 a'-,4 Zip Code:34 9 Fax, 72a 335 ! Rte_
E-Mail: - Phone No.
Fill in fee simple Title Holder on next page(if different E-mail:
from the Owner listed above) State or County License: C,,AC05 !A)0
I .
if value of construction is 2WO'or more,a RECORDED Ndtice of"Commencement Is required.
7,f-0Q
DESIGNER/ENGINEEW-.— Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address;
City. Address:
Ci
State- City: State:
Zip: Phone: Zip: Phone:
FIEE.SIMPLE TITLE HOL—DEER: V 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.LucieCoun makes norepresentation that is granting a permit will authorize the permit holder to build the subject structure
which is In conflict with any aplcable Horne 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 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 acid accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record i 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 recor"jz vour Notice of Commencement, lei
X—
Signature of Owner/Agent/i Signature of contra-am/Ucense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
forgoing instrument was acknowledged before me Thefr in&instrument was acknowledged before rJ11
this -30 day of— =.A0bR<' , 2Q_?S by this I
day of 20 by
AYOC,5 3 P�(.V15
Mwe of person acknowledgii (Name of person acknowl ing)
§Ignature ofA-"t ry Public tate of Florida (Signfiturex Notary Pub c-State of Fldfida
nally Known ✓ OR Produced Identification Personally Known OR Produced identification
of identification Produced.,_. Type of Identification Produced
mission No. rH 604 Z5 Commisilon No..4-7 r 0"114 5 3 9
(Seal) - (Seal)
REVIEWS FRONT ZONING SUPERVISOR- PANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEWREVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev-7/-201:T
1��)61