HomeMy WebLinkAbout1604-0036.?P,LICABLE INFO MUST BE COMPLETED FOR APPLICATION'TO BE ACCEPTED
Date: y-//-/ I(- Permit Number:
Building Permit Application
Planning and Development Services
Building end Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address: �� �' /Lr /fivy
Legal Description:
Property Tax ID #: — agr 3 , Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
ditighal work 1
`Mechanical
_ Electric
_ Gas Tank
Total Sq. Ft of Construction:
Plumbing
Cost of Construction: $
Name
permit — check all that a
_ Gas Piping
_ Sprinklers
Shutters
_ Generator
Sq. Ft. of First Floor:
Block No.
Windows/Doors
Roof
Utilities: —Sewer _ Septic Building Height:
Address: JY4--20 Al A61& /�//� a)"'R- '-� &'�_3
City: rr?A.zA�� State: _rL
Zip Code: L? 'IW . Fax: -V/Y
%�
Phone No. %- �L % /2
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: Lurtts So mrnon_S
Company:
C, s-r,m A« SL-'SfeMn
)&J C,
Address:
1, e l S S& T, 1 (0C, q r,,e n
Dr
City: PC z S T Lid.0 _
State:
Zip Code:
342 Fax: `77a
Phone No.
7 7� 33 S -3 32
E -Mail:
LUJG 1r- Su . (�c ) ' C- m
State or County License: CA C 05 IS /O
S -011 -
if value of construction is259dor more, a RECORDED Notice of Commencement is required.
iSjD
s
NEER: _ Not Applica
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
commencin>; work or recordieR vour Notice of Commencement. 1117
ev.
Signature of Owner/ Agent/lessee
Signature of Contractor License Holder
STACOUTE OF NTY OF FLORIDA � �u �l�
COUNTY OF STATE OF FLORIDA
� /Jf�/
�'f -Ci
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this - day of 4 2r L 20__J by
this - day of d 20_ by
(Name of person acknowledging)
(Name of person acknowledging)
NotaryPublic- �41odridjal�
(Signature of Notary Public -State of orida)
(Signature of
Personally Known ✓ OR Produced Identification
Personally Known OR Produced Identification
Type of Identification ProducedI
Type of Identification Produced
h My COMMISSION # EE 859
Commission No. G' S c�� * EXPIRES: April 4, 201
84 �E 7�`/ �01p0.Y.P6&, I) CHRiSTINE B. ENGUS
Commission No. vT * %tiICOMMISSION #EE 8592
WoedthN8udpe Wary S
es EXPIRES: April 4, 2017
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.