HomeMy WebLinkAboutBuilding Permit Application,?P,LICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: it a `% l �- Permit Number:
S!: L_EACIE
C C3 EA " T 'Y
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
Commercial Residential
Address: /, �� �i �(_�
Legal Description:
Lot No.
Property Tax ID #:
.�N7-���_��`'—�
Block No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
itiona I work to be pe orme under this perm ii — cneci
� Mechanical _ Gas Tank _ Gas Piping
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $'��
all that apply:
_ Shutters
Generator
Sq. Ft. of First Floor: _
Windows/Doors
Roof
Utilities: _ Sewer _ Septic Building Height:
Name Ndn�x� Q U0 �1u r�
Address::)J
City: PeAt,ft Stater
Zip Code: Uj�Y,�- Fax:
Phone No. tl7o2
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: �urti5 Sa4ninor�
Company: Gi ill A ( c 514 fe m_S )LIL,
Address: l%IS S �- Nr I(uak r Dr "
City: Pe 2T S T Lu C 1 e- r State: �L
Zip Code: 34�SZ Fax: 7707 J3S 1 cl6
Phone No. 33 ,5 -3 a3 2
E -Mail: S�4, VC c)
State or County License: CAC 05 1 /O Sae
if value of construction is ZSedor more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: — Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
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 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 record' our Notice of Commencement.
Signature of Owner/ Agent/ Lessee
Signature of Contractor License Holder
STATE OF FLORIDA ,v
COUNTY OF �f
STATE OF FLORIDA
COUNTY OF
vLGC
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this -a day of M _,r'c 6L , 20_ by
this 2.14— day of /14 A 2e rt 20_ by
Cu�i�s AmortS
&r,-T<S 54mmePs
(Name of person acknowledging)
(Name of person acknowledging )
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of F ida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification Produced
Type of Identification Produced
CFVIIISTII�B. p:..., SH
Commission No. C� � / *Mdy �� O s C/ * Iry COMMISSION N EE 859
r �t emission No. / EXPIRES: April 4, 2017
EXPIRES: April
GG � �J
4, 2051 �'+. 7v 6onck Thru Budget Notary Service
Jl4YiCE$ EpF i,�
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014