HomeMy WebLinkAboutBuilding Permit Application,?P,LICA�B/LE�INFO MN'
UST BE COMPLETED FOR APPLICATION BE ACCEPTED
6
Date: 7 � _ Permit Number:
FC--
Planning
C}E.-C3�%�,!T'Y
. . Development
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address: 3 � S r
Legal Description:
Building Permit Application
Commercial Residential %
Property Tax ID #: 1`7 6 � X 0 GYl J r?/ ^F
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
9� 1"Jnr37r. J y s«( r)'Apsc OJT- Shy
itional work to be perrormea un
Mechanical _ Gas Tank
Electric _ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
permit —
Gas Piping
Sprinklers
Shutters
Generator
Sq. Ft. of First Floor:
Utilities:
Name $kite of rL Tr InT jK f 7rusL f uj_ -
Address: 3 q oa C 0 1 m o v1 u} eOJffl ( �
City: I�Q-��� State: -CL
-
City:
Code: 3a 3Fax:
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Lot No.
Block No.
Windows/Doors
Roof
Sewer _ Septic Building Height:
Name: Curtis SOjnrnon -�
Company:
CCAS ,m Vc ST fe m -s
ILL
Address:
I(Q lS S �J; Ilua� Q f n
DT "
City: PCQT T LttC�� r
State: FL.
Zip Code:
342&1 Fax: '�7a
Phone No.
771 33,5 "3�3 2
E -Mail: C 'fi0. 1 f- C, a cr.
S a e
State or County
License: Cfl C 05 IS 10
If value of construction is 2S8Uor more, a RECORDED Notice of Commencement is required.
Not Applica
Name:
Address: State:
City:
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
for
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying
g
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 recorS'Vg your Notice of Commencement.
Signature of Owner/ Agent/
STATE OF FLORIDA y
COUNTY OF d,
The forgoing instrument was acknowledged before me
this day of _� — 20 ih by
(�Ll/QTIS �i�rhAlc �S
(Name of person acknowledging)
(Signature of Notary ublic- a of Florida )
Personally Known t/ OR Produced Identification
Type of Identification Produced - - —
Commission No.
r o`
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMI
Signature
I,dY COMMISSION # EE 85
EXPIRES: April 4,20
Bonded Thru Budget Notary S1
SUPERVISOR
REVIEW
Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this day of 20_--:– by
(Name of person acknowledging)
��✓
(Signature of Notary Publit- State Florida )
Personally Known OR Produced Identification
Type of Identification Produced
`""v Pu'� CHRISTINE B. ENGL
G��S9��f/ " 5e
Commission No. * MY COMMISSION # EE B;
�Icr EXPIRES April 4, 20
,a n n.ar- .. _
PLANS VEGETATION SERA TUIIERRTvLE MANGROVE
REVIEW REVIEW REVIEW