HomeMy WebLinkAboutBuilding Permit Application.i'JPLICABLE INFO MUST BE COMPLETED FOR APPLICATION'TO BE ACCEPTED
Date: 3 ;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 f'
Legal Description:
Property Tax ID #: '?y.,)f P t')' - cc 5;/ ,(y? - / Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side
Left Side:
Block No.
Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction:
so/s'-
Cost of Construction: $
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
Name la&VX,2AW ,v.W Ctit_'_�
Address: dQ5l a ` mac C kt
City: 1 Ce17 / �f ��iJ j e- State:
Zip Code: Fax:
Phone No.L'/�— '�-Os-y
E -Mail
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: C'_urtt5 '�ay'nrnorl S
Company:
Ct,u -r, rig A t r SL1 Ste VnS
1AJ L
Address:
1(e I S S Ti 110 c; r
r\ D,
City: PO ST Lkc�,f_
7
State: FL.
Zip Code:
34�2, Fax: 'T7a
J3S I ��
Phone No.
77Z 33,5
E -Mail:
Cu tky- S�
State or County License: CAC 0 5 1'�
/D - s4atfz
IIIf value of construction is 200'or more, a RECORDED Notice of Commencement is required. I
s
DESIGNER/ENGINEER: — Not Applicable
MORTGAGE COMPANY: Not Applicable
Name:
_
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
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 the Florida Building
plans, 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
work or recorour Notice of Commencement.
Lcomencin
30
Signature of Owner/ Agent/ Lessee
Signature of Contractor License Holder
STATE OF FLORIDA (� ,v
COUNTY OF �f
STATE OF FLORIDA
�
COUNTY OF , oL
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of 20 f- by
this day of M A 2C, rt 20_ by
( uRTa AtnmC4S
C11 r' <S 54 In
(Name of person acknowledging)
(Name of person acknowledging )
(Signature of Notary Public- Stat f Florida)
(Signature of Notary Public- St a of F ida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification Produced
Type of Identification Produced
Q
Commission No. a�e �I % (Seal)
Commission (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.