HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /
Date: Permit Number:
:_. Building Permit Application
Planning and Development Services RF-CEI `+A' I-)
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 'I" � 8 2Q�6
Phone: (772) 462-1553 Fax: (772)462-1578 Commercial ResideC 1r
PERMIT APPLICATION FOR:
Address: q ot CSS
Legal Description:
Property Tax ID#: 22_6? o "7,21 -da O 0 �O � n - "Z Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front-' Back: RDSi Right Side: Left Side:
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Additional work to be performed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _ Plumbing _Sprinklers _Generator _ Roof
Total Sq. Ft of Construction: Iy Oa Sq. Ft. of First Floor:
Cost of Construction: $ -O. DO® Utilities: _Sewer _Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name IC6 cam' e_s Name:
Address: 4-101 Company:
City: 5.]1- . P. e! LQ_ State: Wil. Address:
Zip Code: '3� L4 S Fax: City: State:
Phone No. r "�7 2 - LA 7 S-�c7 7 LO Zip Code: Fax:
E-Mail: �ptc�. f`a-��1n�f-S(c1 Aa 6n c:) . Co CA Phone No
Fill in fee simple Title Holder on next page ( if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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PLANNING & DEVELOPMENT SERVICES DEPARTMENT
Building & Code Regulations Division
• 2300 VIRGINIA AVENUE
FORT PIERCE,FL 34982-5652
(772)462-1553
FILLED LAND AFFIDAVIT
I, the undersigned, am the owner of the following described property,
(Parcel Id#/Legal description/Address)
for which I have applied to St. Lucie County for a Final Development Permit. In
accepting this Final Development Permit, BP Number , I acknowledge
that as owner of the above described property, and in accordance with Section
7.04.01(D), St. Lucie County Land Development Code, I shall be responsible for assuring
adequate drainage so that the immediate community WILL NOT be-adversely affected.
I further acknowledge that in granting this permit for the development of this property,
St. Lucie County is neither obliged nor liable to provide for, or maintain in any form,
adequate drainage off my property which will not adversely affect the immediate
community.
M C,4'C_ C4S 4,-
Property
Property Owner Name(Please Print)
M. C.5,'-4/
Property Owner Signature Dat
STATE OF FLORIDA,COUNTY OF
ACKNOWLEDGElD. BEFORE METHIS DAY OF 201 ;
HO IS PERSONALLY KNOWN TO ME OR WHO HAS
c
PRODUCEDdr AS IDENTIFICATION.
-
SIGNATURE OFARY PUBLIC PE OR PRINT NOTARY
,
COMMISSION NUMBER
(SEAL)
MY_ q HUM
SLCPDSD Revised 04/11/2011 A: r,e EXP1Wt,,-,1.yN#FPNREY
Bonded E5:rYlsr.,,h 174. ;b
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