HomeMy WebLinkAboutBuilding Permit Application All APPLICAB E INF 9 MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: o 0 t �5 Permit Number: �q dl
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-- - Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PRaPC?SED INPROUEMENT
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Address: --� rI f"1 d e72 1. Lo,c k
Legal Description: 1' t ILS �� ��� _`E 1 DiZQ KISS
Property Tax ID#: r' ,mac►(– b " (n59 ""CDC) Lot No.
Site Plan Name: � (' t (1 � Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Mechanic 1 ,GasTarlk. ;Gas Piping _Suiters• Windo� `Dcf5
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Cst of Construct Vin:$` _ r �3 r� ) 1 Utilities: `Sewer ,Septic Building HegYtt:
O'i�li�IRLESSE!~
Name:.: Name: F
Addres C7 1/1 T Company:
City: State: FL Addre k) /07
Zip Coder Fax: City: Luc..
Phone No. `7� � `���7 'Z{e2�_ Zip Code: `,� 6�2 Fax:
E-Mail: Phone No, ?-7Q—,3'Ya_ P" /q0
Fill in fee simple Title Holder on next page(if different E-Mail: a
from the Owner listed above) State or County License:
If value of construction is 250Q or more,a RECORDED Notice of Commencement is required.
DESdGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Nat 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.
1 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 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
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
WA►RNiNG 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 recording our Notice of Commencement.
t Signature of O er/Agent/Lessee 'Signature of Contr f for/License Holder -�
/STATE OF FLORIDA 'STATE OF FLORIDA
COUNTY OF 1_0 C f "COUNTY OF
,The forgoing instru ent was a/,�kn_o�w, ledged�ore me -Th:Nayiof
ng nstr m nt was ac no ledged re me
this ay of t1�'0712Y,20 by 4, ftlii X.Ap ve-)201_6 by
CHERYL A.FINK
(Name of �i,Efipirea Mu 2d.2flYtl ' ,-(Name o �_ol$�PaFi�tl .State of Florhta
�"� o• �o RI ai a FF 1Q,111 ,a My C m area r
�,=',: - �� •.: _ _
(Sign ure'&lVptar)<: blit tate of Florida} r(Signature of Notary blit- to of F(arida j
!:Personally f�nowri, = OR Produced identification Personally Known OR Produir d identification-
_ r. _
€ype of l6eh,156tid't Produced Type of identification Produced
,Commission No:��� (Seal} Commission No, rl,9 (Seal)
REVIEWS FRONT ZONING SUPERVISOR PIANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
QATE
RECEIVED
DATE
COMPLETED
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