HomeMy WebLinkAboutBuilding Permit Application,PPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: J -1 a — I W 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 1
PERMIT APPLICATION FOR:
Address: 5LC l "3 Fe_ ,t)b l c_ �5eC_ch
Legal Description:
Property Tax ID #: Ute✓- — C�L� J % ' 7
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
aitional work
_Mechanical
Electric
_ Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ �/�/Ko
Name ' , ec,-n 1-\ Y_r-C)C K
permit —
_ Gas Piping
Sprinklers
_ Shutters
_ Generator
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic
Address:_ \l C,,1 N_(; I(-- Cn , `I
City: Emu 1 Ck\he State: ll._
Zip Code: Fax:
Phone No. c,75 L-A C=
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: Curt t s Sam in on S
Company: CAA5-r,m Vr S!�sfems INC
Address: l( IS S E I i I (arg �reeN Dr "
City: Po z �'t LkC i� State: FL.
Zip Code: 34252j Fax: ` 7 33S
Phone No. 771 335 -U -32-
E -Mail:
-32-
E-Mail: Cutor SS4 G0L m
State or County License: U C 0 5 1,� 10
If value of construction is2590"or more, a RECORDED Notice of Commencement is required.
e
_ Not Applica
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: _
Address:
City: _
Zip:
Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Arlrlracc• _
CitState:
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 Counttyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
ssttructure. Please consult withpyourr Home OwnOwners
rs Assoc ation and reviebylaws
y ur deed fr any restrictiots ns s wh restrict
h maor
alprohibit such
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 recorAg your Notice of Commencement
Signature of Owner/ Agent/
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this day of & A� , 20 -1 by
(Name of per5Qn acknowledging)
of Notary14c- State of Florida )
Personally Known i / OR Produced identification
Type of identification Produced
,a c MY COMMISSION # FF 014539
Commission No. / °iy� fs PIRES: May 5, 2017
Bonded Thru Budget Notary Services
REVIEWS
DATE
COMPLETE
Signature of
STATE OF FLORIDA
COUNTY OF
Holder
The forgoing instrument was acknowledged before me
thisL day of I H'�;__ 20 ' r by
Cvrl/�J_5 SG1"Mp1n S
(Name of person acknowledging)
(Signatur,1e of Notary P / lic- State of Florida }
Personally Known OR Produced Identification
� JAMES IARVIS
Type of Identification Produced SRL °uzMY COMMISSION # FF 014539
�12-/ 3 * * a PIRES: May 5, 2017
Commission No. � �PlEp��OQ BondedThruBudgetNotaryServices
FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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