HomeMy WebLinkAboutBuilding Permit Application,PPLICABLE INFO MUST BE COMPLETED FOR APPLICATION'TO BE ACCEPTED
Date: I`�o2.S �� Permit Number:
Planning and Development Services
Building end Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address:
Legal Description:
73 �6 �,�ine. A' x -f -A
Building Permit Application
Commercial Residential
Property Tax ID #: �3�d -a�3- Mea - Pee d
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side
Haamonai worx to oe perrormea unaer
Mechanical Gas Tank
Electric _ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ .>`%�
Left Side:
",A I'S c- v J(' C , lit/
s permit — check all that apply:
_ Gas Piping _ Shutters
Sprinklers _ Generator
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic
Lot No.
Block No.
Windows/Doors
Roof
Building Height:
N a m e &Id l AIP4 d A�
Address: 1W a44ek'4 anl!�e 9
City: DQ V,64 v State:
Zip Coded iX 9c FV= cc eD a76 29 / 13 0 D
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: �urtls Sa4rlrnori S
Company: Cus-r�m Atr S�SfeMS )AJC.
Address: I, I S Sr_ T i l loa a_ J ren Dr -
r
City: 'POP -7 ST UCte. State: FL.
Zip Code: iii �SZ Fax: ' U 33S 1461
Phone No. 771 33,5 " 332
E -Mail: (Lu St41(- S�< <P C*'o)-('M
State or County License: Cfl C 05 G, !O ' S4mfe.
If value of construction is2580'or more, a RECORDED Notice of Commencement is required.
Iry 0
It
DESIGNER/ENGINEER:
_ Not Applicable 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.
x x
Signature of Owner/ Agent/"Lessee Signature of Contractor�License Holder
STATE OF FLORIDA
COUNTY OF &
The forgoing instrument was acknowledged before me
this a day of d/"_� by
(Name of person acknowledging )
(Signature of Notary Public- State of Florida )
Personally Known - OR Produced Identification
STATE OF FLORIDA >, ��
COUNTY OF -✓
The forgoing instrument was acknowledged before me
this _sday of � 20 „. by
(Name of person acknowledging )
(Signature of Notary Public- State of ZYida��/
Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced 01I "�,>mn.S
RY PU MY COMMISSION # EE 85925'
�€ /(�7,j7y �otP.•..e' CHRISTINE B. ENGLISH �� �� �C * I
Commission No. J o`er al)MYCOMMISSION#EE 859 ommission No. _ )EXPIRES: April 4,2017
* EXPIRES: April 4.2017r 4i �•F`oa� Bonded Thru Budpt Notary Serkt
Bonded Thru Budoet Notary Sets es
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014
SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW