HomeMy WebLinkAboutBuilding Permit Application.RPLICABLE6IINFO MUST BE COMPLETED FOR APPLICATION' TO BE ACCEPTED
Date: 1' �iL 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:
Legal Description:
�9J
0
Property Tax ID#: -/ Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front
Back:
Right Side:
Left Side:
Mechanical
Electric
Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
—t
Name Nvid 4TYUC-e6o. (oLclar+_
Gas Piping
Sprinklers
_ Shutters
Generator
Sq. Ft. of First Floor:
Windows/Doors
Roof
Utilities: _ Sewer _ Septic Building Height:
Address: 43 D(J IMeLLvA(ivn. Kc�
City: -► &wdeRSnf ��q State: G
r
Zip Code: �(Jd'7 Fax:
Phone No. 770"sla'R6sq Ic7�''5�, --450
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: curbs '�AMmohS
Company: Cus-r&'rM A i,r 5�1 S fe ms ki G
Address: [( IS SG- Ni l(ar,a. Q r-eer, D, --
city: PoeT ST LttC%e_ r State: rL_
Zip Code: 342_52) Fax: '77a 335 ) X16 N
Phone No. 71.2 3)_32
E -Mail: CUSfi(kIr' Sci �p Cc 1 r,M
State or County License: CAC05 IR /O S�0_te_
If value of construction is 2 48Tor more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER:
Name:
Address:
Citv:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address
City: _
Zip: _
Phone:
_ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name:
State:
_ Not Applicable
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 Coun 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
commPncing work or record{me vour Notice of Commencement.
Rev. 71ZU14
Signature of Owner/ Agent/ Lessee
Signature of Contractor License Holder
STATE OF FLORIDASTATE
�� 4)cI-'Q
OF FLORIDA
COUNTY OF ,a ZgeZ e
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this __� day of 120 / 6by
this _7�_ day of 4,444 +�-� 2pr 6 by
711 ,�,O 1904 �
(Name of person acknowledging)
(Name of person acknowledging )
(Signature of Notary Publi Staterrida )
(Signature of Notary PuVic- Stat V11Florida)
Personally Known r OR Produced Identification
Personally Known OR Produced Identification
Type of Identification Produced
Type of Identification Produced
.• * * �% RIS71NE B. ENGLIS
C.G �,5�D�+�`TOaj)MY COMMISSION # EE 859
CHRISTINEH
// / f COMMISSION # EE 85928
4rommission No. CiC J aI�EXPIRES.Apri14,2017
Commission No.EXPIRES: April 4, 2017
"t OF FVQ*" Bonded Thru Budget Notary Se
'a'Foc f�°e`Op Bonded Thru Budget Notary Service
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 71ZU14