HomeMy WebLinkAboutBuilding Permit Application,?PLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �/ _/Y _/6 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: /71z
Legal Description:
Property Tax ID #: ),303 J0dv,5 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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: $ ���% S Utilities: _ Sewer _ Septic Building Height:
Name J�Mdlt, a L_YaMli
Name: i'urtt5 ' aO_Mrnon S
Address: /7/2 *"64t) �i�xaL'a�
Company: CAAu;-rr�m F)ir ��S+ems
kic,
City: 7o2t /14z;L State: /L
Address: t(iS S6 9)1 1(0aa. r,;en
D,-
Zip Code: 3 y9 S Fax:
City: PC, QT S T LkC kC
State: rL.
Phone No. //7 ^a XW '-Lf/Y%
Zip Code: 34 9-S� Fax: `lU
338 ) ct X
E -Mail:
Phone No. 77,E 33,5 -30-32
Fill in fee simple Title Holder on next page ( if different
E -Mail: Lusfiaic 1, t V coo) .",esti
from the Owner listed above)
State or County License: CA C 05 1 ,� /O
If value of construction is 2S6dor more, a RECORDED Notice of Commencement is required.
7,-0'0
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MORTGAGE COMPANY:
_ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: 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 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 recor ' g your Notice of Commencement.
Signature of Owner/ Agent/'Lessee Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this day of 20 by
(Name of person acknowledging)
STATE OF FLORIDA � p
COUNTY OF 'Z Z'_"'e_
The forgoing instrument was acknowledged before me
this I day of 119A I / , 20_ by
71,mu,; n S
(Name of person acknowledging)
(Signature of Notary Public- Stat Florida) (Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
o/ p "�;.;° < CHRISTINE B. EN&ISH CHRISTINE B. ENGLISH
Commission No. �CoJ ��o MY COMMISSION # EE }51l®tnmission No. z.J alj�y COMMISSION # EE85928-
k EXPIRES: April 4,17 EXPIRES: April 4, 2017
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40-e Bonded Thru Budget Notary sir'
ces 41' 3o,ded 7hn: [iudoot Nat,4 SuJvc
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COUNTER REVIEW
DATE
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DATE
COMPLETED
Rev. 7/2014
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