HomeMy WebLinkAboutBuilding Permit Application.PP LICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: LI - I- 1(.e Permit Number:
R
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: ISoC I t"i C41 Pr t�_ y ot
Legal Description:
Property Tax ID #: I I 1 y Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction:
Cost of Construction: $ �3 '7 kov . Co
Name , P -k: ce_
Address: i ,_4y Lck\Ge_ G hone, QLCL
City: b ween L ooW L-o-�ce, State:
Zip Code: I Oq Q. 5 Fax:
Phone No. � y5 -Loy9 , 33ycj
E -Mail:
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: (+urtt5 So-mmon _�
Company: _ Gs -re to A l (- SL1 S to JInS IAJ C.
Address: (( IS S E T r I (Ctae. Q rr,,en Dr -
City: V09 -T ST UC IC_ State: i L.
Zip Code: 3 SZ Fax: ) ct S
Phone No. 77) 53,S 33.32
E -Mail: Lutklf- s�4 S a0 c,c
State or County License: CA COS !O S�o-le.
If value of construction is2.5e0'or more, a RECORDED Notice of Commencement is required.
It
DESIGNE 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 makes no representation that is granting a permit will authorize the permit holder to build the subject structure
structurin e. Please consult withpyourr applicable
ome Owners AssAssociation
Association and revieybylaws deed for any est that
which may al. prohibit such
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 recorAg your Notice of Commencement /J
Signature of Owner/ Agent/
Signature of
Holder
STATE OF FLORIDA , / I STATE OF FLORIDA
COUNTY OF & � 0'e— COUNTY OF i
The forgoing instrument wa acknowledged before me
this ;' day of I by
�L,(U[►��) rna1c' �S
(Name of person acknowledging)
(Signature of Nota77i6 State o orida )
Personally Known OR Produced Identification
Type of Identification Produced
CHRISTINE B. ENC
Commission No.J y / * MY COMMISSION t EE
EXPIRES: April 4,
1'r>- ..e° Buided Thru Budget"
REVIEWS FRONT ZONING
COUNTER REVIEW
RECEIVED
DATE
COM PLET
The forgoing instrument was acknowledged before me
this day of 20 by
N ut 1
(Name of person acknowledging )
(Signature of Notary Public- State of Florida
Personally Known r,- OR Produced Identification
Type of Identification Produced
CHRISTINE B. ENGLISi i
5g�imission No.
ISH �'' S OXY OMMISSION # EE 85923;
�� � 7� * • (�
s. EXPIRES: April 4, 2017
117 F 3F I`oa° Bonded Thru Budget Notary Services
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