HomeMy WebLinkAboutBuilding Permit Application .y}PLICABLE INFO MUST BE COMPLETED FOR APPLICATION'TO BE ACCEPTED
Date: �a�g'�S� Permit Number:—L 1 ,2- - ® � y I
RECEIVED
Building Permit Application DEC 0 4 201
Planning and Deve/opmentServices PERK ITTINGSt. Lucie County, FL
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 3498Z•
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address: �e--
Legal Description:
Property Tax Id M 9 LW7 / -e,!;AV Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
OU
/ A&l
Additional mor to ape orme un er t is permit-check a t a y:app
�!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:$ �, p Utilities: ,Sewer _Septic Building Height:
Name:— Curtt5
Address: c?S- Company: 'r ,` C
City: ,41 State:. Address: (k 15 S G. V i I{ a.-v �rwA- - r - --
Zip Code: m f<U Fax: City: T ST e i " � �
State: FL.
Phone No. Zip Code:_ZA.M _ Fax: 77A 3_�5l'��_ _F
E-mail; Phone No. 7'71 _,?L5 -3x32
Fill In fee simple Title Holder on next page (if different E-Mail:__ C- stC Jr sQ ao 1 �,
from the Owner listed above) State or County License: Chi. 05 t,?10 54mie.
If value of construction i525 for more,a RFCORDED Notice of Commencement is required.
e,
Ct1E SIGNERJENGiNEER: Not Applicable MORTGAGE COMPANY. r „Not Applicable
Name- Name:
Address: Address:
City: State. City: State:
Zip: Phone: Zip:_ Phone:
FEE 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 county makes no representation that is granting a permit will authorize thepermitholder to build the subject structure
which is in conflict with an applicable Home Owners Association rules,bylaws or an covenants that may,restrict or prohibit such
structure.Please consult wrath 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 and accessory uses to another non-residential use
WARNING TO OWNER:Your failure to Record a 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 record' our Notice of Commencement.
Signature of Owner/Agent/ essee 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
this day of r�'c�. ,20 by this�day of &C . .20 by
ti
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary P,ub/lic� Stat Florida) (Signature of{votary Public, to of Florida)
Personally Known OR Produced identification Personally Known OR Produced Identification
Type of Identification Produced b _ e�� Type of Identiflcation Produced
"iS D Ct G if�Y Pll
Commission No. 'J"9� 1�iYco�l�i�s�az� 1�� commission No. �' r ��.•"`�= � 8.tt4W8H
s EXPIRE$,Apr11�4,2017 C1�14�1 IONIFE859284
r� o� k'*T'ft&V o q Sera) r„ ERPIRES:Aprll 4,2017
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
)GATE
RECEIVED
DATE
COMPLETED
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