HomeMy WebLinkAboutBuilding Permit Application.PPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: L4 - I - 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: I 1 U act CL.%-Vb5
Legal Description:
Property Tax ID #: 3 L4 a'1 - I l 1 - 00 a - O 0 O - S Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
ItI na wor to a pe orme under this permit - check a that appy:
Mechanical _ Gas Tank _ Gas Piping _ Shutters Windows/Doors
Electric _ Plumbing _ Sprinklers Generator Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ ��� Utilities: —Sewer —Septic Building Height:
Name n t)()C-k in e"hn'k Name: (±lacus so-m rn on
Address: I 1 _ u(�r� 0 .c3.v-IC>5 Company: Cu5-ang R (- Sit S fe MS )AJC
City: or'r . State: 'F L Address: I, � I S S & 'Vi 16Q,, Q r,,,eN Di-
Zip
rZip Code: 3L{aS0 Fax: City: PQ2T ST LlkC ilf_ State:
Phone No. !I 22 - 3ya,- pi L01 Zip Code: 34 q_�2 Fax: 'TL J35 1 `2 X
E-Mail: Phone No. 7702 33,5 _32_32
Fill in fee simple Title Holder on next page ( if different E-Mail: CJiJc�kr s4 "g, Go )
from the Owner listed above) State or County License: C C 05 1S /O
If value of construction is 2.5e0'or more, a RECORDED Notice of Commencement is required.
Name:
Address:
City:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: _
Not Applicable
State:
Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Arlrlracr
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 record4g your Notice of Commencement /2
Signature of Owner/ Agent/
Signature of Contra cto r[License Holder
STATE OF FLORIDA j STATE OF FLORIDA
COUNTY OF
COUNTY OF
The forgoing instrument wa acknowledged before me
this i day of t 20 by
AIUL�S�roqefls_
(Name of person acknowledging)
The forgoing instrument was acknowledged before me
this day of -A12 (Li , 20_by
0�t LiLL &A W n S
(Name of person acknowledging)
(Signature of Notary Public- State o orida) (Signature of Notary Public- State of Florida
Personally Known v OR Produced Identification Personally Knowny OR Produced Identification
Type of Identification Produced Type of Identification Produced
CHRISTINE B. ENGLfSti
CHRISTINE B. E SH p r
. 5 �/�'* _ * MY COMMISSION # EE 5QW mission No. f s� 0 *0�'�egl�OMMISSION # EE 85928;
Commission No. EXPIRES: April 4, 2017
EXPIRES: April 4, 017
fBonded Thru B
Rmded Thru Budget Notm ervices Fov v Budget Notary Services
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REVIEWS I CFRONT ZONING PLANSO NTER I REVIEW I S REVIEWOR I REVIEW I V EVI WON S REV IE
I MREVIEWVE
DATE
RECEIVED
DATE
COMPLETED