HomeMy WebLinkAboutBuilding Permit Application,?P,LICABLE INFO MUST BE COMPLETED FOR APPLICATION'TO BE ACCEPTED
Date:
s-
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address: j(20,2 &t'
Legal Description:
Permit Number:
Building Permit Application
Commercial Residential
Property Tax ID #: 3W` IYL 6122 160rz� -" � Lot No.
Block No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
L 11tc //-t L/!rc 2'1"�A IVS«r r�AAS- c O J< /0h4—�
Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction:
Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: _ Sewer _ Septic Building Height:
Name RonalJ 01121n d-KL1 l Sahc�tinc-I�,Isv
Address:Laz '�l'ce of
City: & T ST 4 tee i e State: r l
Zip Code: ?V g5�2- Fax:
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: LU(bs Samrnon,5
Company:
C,(A5Tn M « SLJ S fe Mn
Jk C,
Address:
1(e l S S T1
Dr "
City: Po z TI u���
State: FL
Zip Code:
349 Fax: `77a
335 ) `L
Phone No.
77,2 33,5"'3x32
E -Mail: C 'U I r c l ' M
State or County
License: CA C 05 IS (O
If value of construction is 2.590'or more, a RECORDED Notice of Commencement is required.
7<'DD
i
Not Applicable
Name:
Address: State:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: State:
City:
Zip; Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name:
Name: Address:
Address:
City:
City:Phone:
Zip: Phone: Zip:
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 Counter makes no representation that is granting a permit will abylews or and covenants holder to
maydrestrictborr prohibit such
which is in conflict with any applicable Home Owners Association rules,
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
lt in
our
ce for
WARNING TO OWNER: Yourfailure Notice of Ca Notice of ommencement�must be recordedencement may uand posted ongthe�jobsite
improvements to your property.
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recorS!'Jg your Notice of Commencement. ,
Signature of Owner/ Agent/ Lessee
STATE OF FLORIDA l
COUNTY OF Jt��°
The forgoing instrument was acknowledged before me
this day of 20 by
(Name of person acknowledging)
(Signature of Notary ublic- a of Florida )
Personally Known i/ OR Produced Identification
Type of Identification Produced I
�� �S�9d �`� * cl} My COMMISSION # EE K
Commission No. EXPIRES: April 4, 20
_11 T v v�°p Bo^d9d Thru Budget Notary 5
REVIEWS FRONT ZONING COUNTER REVIEW SUPERVISOR REVIEW
DATE
DATE
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF fes' e
The forgoing instrument was acknowledged before me
this , . day of 20 by
(Name of person acknowledging)
(Signature of Notary Publit- State FW
Personally Known OR Produced Identification
`Type of Identification Produced
CHRISTINE B. ENGLI
Commission No. �\ * MY COMMISSION # EE 8;
EXPIRES: April 4, 20
ices
PLANS VEGETATION SEATURTWLE MANGROVE
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