HomeMy WebLinkAboutBuilding Permit Application.PP LICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: -& Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Building Permit Application
L�Commercial Residen i t aI
Address: *'�f y /i h�� /)/-
Legal Description:
Property Tax ID #: tyW-J 17e %-41214'-41 �X Lot No._
Site Plan Name: Block No.
Project Name:
Setbacks Front
Back: Right Side: Left Side:
1111e- Z, 11Y-e—
/o
dition-al work to be pertormed under this permit -Check an that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction:
Cost of Construction: $ y &-5
If
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
Name fA E r F' l l a- R o N "t. ; I CLQ.. 't r
Address:_ 6o`{& q r� �y Qom_ Lim
City: P6 e -T �;-T Lane State: F_L-
Zip Code: 3 q qS .2 Fax:
Phone No. r1'7a 34C 176 I
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: /'urbs Sc mrnon S
Company: ('u5Tr�N1 VC S'lSfeimS INL
Address: 1, e i S SE Ti 1(0Qa� Q ren Dr
City: Vc T ST L1lCie-- State: rL.
Zip Code: 342 Fax: `17a J3S- ) �X
Phone No. 771 33,5 "3d-31
E -Mail: LUtiTckV- S�4 : V C'c I C,cr\
State or County License: CA C 05 I,� /O S�0-1k-?
If value of construction is 25e0'or more, a RECORDED Notice of Commencement is required.
e
ORTGAGE COMPANY: — Not Applicable
DESIGNER/ENGINEER: _ Not Applicable Na
Name: me:
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 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
commencing work or recori;4g your Notice of Commencement.
Signature of Owner/ Agent/ Lessee
Signature of Contractor License Holder
STATE OF FLORIDA � ,pub
COUNTY OFSTATE OF "p "
�e
COUNTY OF �LGe
The forgoing instrument was acknowledged before me
The for oing instrument was acknowledged before me
7 /6 by
this? day of A14 F_ 20 16 by
this day of /14A -k 20
C)�-T1S ��}MMvrLS
r_t(.S �>��Ma►tS
(Name of person acknowledging)
(Name of person acknowledging )
(Signature of Notary Pub State State o orida )
(Signature of Notary P blic- St of Florida)
OR Produced Identification
Personally Known `� OR Produced Identification
Personally Known
Type of Identification ProducedType
of Identification Produced
CHRISTINE B. ENGU
EE�SJ,Z�y I MY COMMISSION # EE 85
Commission No. *
H ` p p P^' 'ue, CHRISTINE B. ENUIS
2tommission No C� G�0�9�0 �o ' S I) MY COMMISSION # EE 859 1
EXPIRES: April 4, 20
7 * EXPIRES: April 4,201
,r^rte _F v�oP�OP Bonded Thri Budget Notary S
ices o B^ectad Thm Budget Notary Se
REVIEWS
FRONT
ZONING SUPERVISOR
PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER
REVIEW REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.