HomeMy WebLinkAboutBuilding Permit Application.PPLICABLE INFO MUST BE COMPLETED FOR APPLICATION'TO BE ACCEPTED
Date: J^ /0 -1 b. 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:
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front
:3'f q a OAA _R ��a-,o.�.r
3+25- Toy - ovo8 -01 o -4
Back
Right Side
Left Side:
Lot No.
Block No.
P /Zo( L/KP oo .SPS �/A nsC_ ✓ i
,22,,-7 sPe-r HAqT_ov1Y1'P /v- i -/ex -f- sTi-V
Mechanical Gas Tank
Electric _ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ 0Q
_ Gas Piping _ Shutters _ Windows/Doors
_ Sprinklers _ Generator _ Roof
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
Name So_A�-,,, m C I L lo PDR I nc-
Address:y 9)L (`AAiMf3rJ_ . 1_/1City: Ctt St State: L
Zip Code: 3 yS.L Fax: 5 *0 -0 Sa - —
Phone No. 340- 18VY
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: �Urtt5 .So_mmon S
Company: CAas-r m A t r Sj S fe ms Biu
Address: Ile l5 5 `fir I Icr. 9 ren �� "
City: Po2_7 ST UC to d State: F -L
Zip Code: 34 qS2) Fax: '77�
Phone No. 771 33,5 -.332
E -Mail: CUSfioIif- S� ; V C,c 1 -r, cm
State or County License: C A (! 0 5 ),? 10 S- cJe
if value of construction is?SeG'or more, a RECORDED Notice of Commencement is required.
7,�-D 0
It
Name:
Address:
City:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
State:
Not Applicable
•-a- ---w11 niv 1.
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
State:
Not Applicable
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 recor ' g your Notice of Commencement.
Signature of Owner/ Agent/ lessee Signature of Contra cto r�License Holder
STATE OF FLORIDA y
COUNTY OF
The forgoing instrument was acknowledged before me
this day of 20 ' - by
11711k TSS J; iM no&
(Name of person acknowledging) /
(Signature of Notary Public- State Florida )
STATE OF FLORIDA �o
COUNTY OF
The forgoing instrumentwzis acknowledged before me
this �ti
day of 44 , 20/�/ by
4X4971S �Imv�s
(Name of person acknowledging)
(Signature of Notary Public- tate of rida )
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
15"'RY P(,B!10 CHRISTINE B. ENGL'SH o' uB
Commission No. �i�?S/ �c%* )* MY COMMISSION# EE&9�{yimmission No.G J/�OCHRiBnNE6.ENGEi
�p
EXPIRES: April 4,2 17 * * MY COMMIS SION#EE 859
,'7F Fitl1'' Bonded Thru Budget Notary skvices �.- EXPIRES: April 4,201"'
I ` bitlad�-;r� aU N
otwy S ,.aryl
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. //2014