HomeMy WebLinkAboutBuilding Permit Application .RPPLICABLrr INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 zolLe Permit Number:
REC.EI`."_D JAN 0 6 2016
Building Permit Application
Planning and Development Services
80ding and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)452-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: J ��
Address: 2$,3 7 On e, lov P+ PJac-e-,
Legal Description:
Property Tax Ip#: 335 q b 66- ODd-0Q, Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front_._- Back: Right Side: Left Side:_.._.
Z_llte POr L%Ice ' s /YSIr-C! CAIknSG 06"1
Additional work o be perFormed under this permit-che!ck all tat appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
T Electric _Plumbing _ Sprinklers —Generator Roof
Total Sq. Ft of Construction: Sq- Ft-of First Floor:
Cost of Construction:$ 2 Utilities: `Sewer _ Septic Building Height:.__ _
Name 1n Name: Curtly S mrnon S
Address:_ Company: 1,LaZC2M Air 5�4 S fe ons fru C,
City: t cat State:_U Address: i 15 S C °U 1 1(a x,_GQs'�n D.-
Zip Code: n�1S 6,(r] Fax: City. Poe-r S-r uc le- -- ---State:
Phone No. *q tab 30(o --. $)(D I __ -- Zip Code:-54 9Z Fax: '772 3,35 1 oto�
E-Mail: _ — Phone No._ 77. 1i -3d-3 2-
Fill in fee simple Title Holder on next page(if different E-Mail: Cu Ste,Ir �w 5.t C_o 1.6cm
from the Owner listed above) State or County License: CAC 0 5 I R 1 D • 5�afe '
If value of construction Is25edor more,a RECORDED Notice of Commencement is required.
POESWRNI1rNGINEIrFt: _Not Applicable MORTGAGE COMPANY: 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 Count�yy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflict with any pplicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult wit�i your Home Owners Associat-ion 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 fallure,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'qg yourrecord' Notice of Commencement.
Signature of Owner/Agent/lessee Signature of Contractor License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF A r✓ o ' Cxr+ COUNTY OF
The forgoing instrument was acknowledged before me Thefar Ding instrument was acknowledged before me
this day of;,�n�?ay-�+ .20)fo by this day of 20 /V by
Yl es
(Name of person acknowledging) (Name of person acknowledging)
A 9U.Lt zi
(S gnature of Notary Publ State of Florida) - Signature of Notary Publ -State of Florida)
Personally Known ✓ OR Produced identification Personally Known _LI/ OR Produced Identification
Type of Identification Produced Type of Identification Produced
DOML.JO E 00 IFFM
Commission No. )-1= J�/3 ..5. * *1r4V00tV911S NffF 2019 mission Na. rFa 72 .. `. *= 5
,2019
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REVIEWS FRONT ZONING SUPERVISOR PIANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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