HomeMy WebLinkAboutBuilding Permit Application.PP LICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: d /D /l
Permit Number:
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:
Address: Sri/ ,QQ rz &/) /_
Legal Description:
Property Tax ID #: '��;z " �l y - �? - C ey? "z/ Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back:
L 111le lZ�,r j /l'<, 3-1-:;,
ionai worK to De pe
Mechanical
Electric
_ Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
Name // .�/XC4
Right Side:
CAP/"55C
is permit - check all that
_ Gas Piping
_ Sprinklers
Left Side:
apply:
_ Shutters
_ Generator
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic
Address: /0 /✓ JX&t 7�-t'
City: �)Qhy;//,E State: IL
Zip Code: Fax:
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Block No.
_ Windows/Doors
Roof
Building Height:
Name: LUrt(5 so-mrnon S
Company:_1s-roM
At'r SLISfeMS
)AJC.
Address:
i( l5 S E Nr 1(ua� Q rcn
D/- -
City: �OUC
ST L1J.0 if_ r
State: rL.
Zip Code:
342-52) Fax: '7'7,1
33S )� 6 9
Phone No.
3932-
77 3L,- -3932
E-Mail:
E-Mail:
' f_i►''ljar-VIs C 6_113C10441.
_
State or County License: Cfl C 05 1,?(
/O - S- 0_le
If value of construction is2SKor more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address
City: _
Zip:
Phone:
State
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address
City: _
Zip:
Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name: _
Address:
City:_
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 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
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
commencina work or recor our Notice of Commencement.
X
Signature of Owner/ Agent/ Lessee
J6
Signature of Contractor License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
COUNTY OF Sr Z0' -/'Q
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of f' 6 20[� by
this �0 day of �.�6 , 20 Z by
Z/Z PTiSy,41nJn t9 rl S
�C� �PTiS SAO' ll i// Q i,, S
(Name of person acknowledging)
(Name of person acknowledging )
(Signature of NotaryPublic- SkAe of Florida)
(Signature of Notary Public tate o orida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification Produced
Type of Identification Produced
E� �� 2� .... e
Commission No. * _ l
H
y COM q ' / CHRISTINE B. ENGLISH
MYOOMMISSiON#EE851�ommission No. r����/a�y y �
EXPIRES: April 4, 2017 ` �"'��biY COMMISSION # EE 859
6m&d Thru Budget Notary Se,
iices EXPIRES: April 4, 2017
i
'Qk R�,,,W Trut Wary Sem
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014