HomeMy WebLinkAboutBuilding Permit Application.?PLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: : J Y Permit Number:
Building' Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 l
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address;
Legal
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name: _
Setbacks Front
Z_M
Mechanical
C e' SS �- D re -
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Back: Right Side: Left Side:
z'1L /1 � s ��s lis«.� C -1A ns rl(
•med under tnls permit- cnec
Gas Tank _ Gas Piping
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 211 -
apply:
Shutters
_ Generator
Sq. Ft. of First Floor: _
Utilities: _ Sewer _ Septic
Name ,�ehr�,e- CUQ 1�_e,
Address�-
City: _ 1 -orf P,'eFce- State: _! .
Zip Code: Fax:
Phone No. rt `1 - 3 i - ci 5& L4
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
Building Height:
Name: Curtt5 SoLmrnon S
Company: ('us r��n� A « M,� 1>u c.
Address: Ile I S S E M I lu a ree n Dr
City: Poq_z ST LkCif_ _ _State: FL.
Zip Code: 342SZ Fax: ` U 335 1 X26 �
Phone No. 771 33,5 -3�_3 2
E -Mail: (Lusfic��f- Su .0 ac ) (�M
State or County License: CAC 05 IR 10
If value of construction is269dor more, a RECORDED Notice of Commencement is required.
i
Name: _
Address:
City: _
Zip:
EER: , Not ApplicableI MORTGAGE COMPANY: _ Not Applicable
Name:
Phone:
State:
FEE SIMPLE TITLE HOLDER: — Not Applicable
Name: _
Address:
City: _
Zip:
Phone:
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
commencing work or recordiVgyouur Notice of Commencement -4
Signature of Owner
STATE OF FLORIDA
COUNTY OF ->
The forgoing instrument was acknowledged before me
this day of /' 20JI by
l'7l�S _��,�^^ll'►n�5
(Name of person acknowledging)
(Signature of Notary Pups c- State of Florida )
Personally Known // OR Produced Identification
Type of Identification Produced -NY "°^ 4 __.�S JARNS
*O�F
MY COMMISSION # FF 014539
Commission No. �1^ oio-3 % ealFXPIRES: May 5,2017
Bonded Thn Budget Notary Sen ices
REVIEWS FRONT
COUNTER
DATE
DATE
Signature of
STATE OF FLORIDA
COUNTY OF
Holder
ST- t,4 / cle
The forgoing instrument was acknowledged ¢efore me
this day of Ir, ta.;.1 , 20, by
(• t./ rr/S So molvim
(Name of person acknowledging )
(Signature o tary Publi - State of Florida }
Personally Known OR Produced Identification
Type of Identification Produced JAWS JAHM
'3 C' Y,�OMM
Commission No. ISSION # FF 014539
f J" y} * (e PIKES: May 5, 2017
BondedThrukdoNo"Serkes
REVIEW I SUREVIEWOR I REVIEW I PLANSvREVIEWEGETATION I SEA REVIEWLE �MREVIEWVE