HomeMy WebLinkAboutBuilding Permit Application -.PVUCABLE INFO MUST BE COMPLETED FOR APPUCATIOM'TO BE ACCEPTED
Date: Permit Number: ( I I- n Z o
RECEIVE®
Building Permit Application DEC 15 2015
Plonningan'd DevelopmentStrvice5 PERMITTING
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 .Commercial Residential
PERMIT APPLICATION FOR:
Address:
Legal Description-
Property Tax ID#: .�J'a� 7�0� -��1�'Q�Q Lot No,
Site Plan Name- - Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
�tyona wo to a pe rme un er �s perms –c ec a t a app y:
—Mechanical `Gas Tank _Gas Piping Shutters Windows/Doors
Electric w.Plumbing _Sprinklers Generator `Roof
Total Sq. Ft of Construction: _ Sq. Ft.of First Floor:
Cost of Construction:S_ _ �1a _ Utilities: „Sewer _Septic Building Height:
Name &7�0 (+ro/SSG�a.Lr Name: Curtis Saymrnon S
Address: Company:C.&9TIPM R i r Sus+e.w )ju r
City: f,G-dorua� ��} _State: Address: I!�15 S �J i II lc Qrn D/
Zip Code_ /50'/'-/ Fax:_ City:-&-T ST ujc« � State: >-L.
Phone No. ZipCode: 3495 _ Fax: '77J :335 l 94 9
E-Mail- Phone No. 77� . 3, ,5 •'3;32. T–
Fill in fee simple Title Holder on next page(if different E-Mail:_ . cIL4td i� egy: y Co l.�c-m
from the Owner listed above) State or County License:_ CA C 0 5 o?1025-�a 2 '
If value of construction is2XPOWor more,a RECORDED Notice of Commencement is required.
7�a4
e.o
DESiCNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: Stater
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 the hermit holder to build the subject structure
which is in conflict with any applicable Home Owners Assodation rules,bylaws or And covenants that may restrict or prohibit such
structure.Please consult with your dome 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 fallum 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 recordive yourrecord' Notice of Commencement.
Signature of Owner/Agent/lessee Signature of Contractor License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF i2 &LKK r COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instru ent was acknowledged before me
this�day of ,20Z_r by this__..y_day of ,Je-- 20JX by
`fir /S �G ,. -_ b YW
- - -
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pyblic-S bf Florida} (Signature of NotaryPu c-St of Florida)
Personally Known OR Produced identification Personally Known OR Produced Identification
Type of Identification ProducedType of identification Produced w?n
_ g�,r :t
Commission No. � �� OI,tM!$SXkN1EEii5928+1 Commission No._
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REVIEWS FRONT" ZONING SUPERVISOR PLANS ViEGETATiON SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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