HomeMy WebLinkAboutBuilding Permit Application.PPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: CS-/? /6 Permit Number:
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: I Off'
Legal Description:
Building, Permit Application
Commercial Residential
Property Tax ID #: �������-��� Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
���� lZ'� Lllt� y i'�•n Ivser( 0AnSC DVI, �O�c
ditional work to be pe
Mechanical
_ Electric
rmed under this permit - c
_ Gas Tank
— Plumbing
Total Sq. Ft of Construction:
_ Gas Piping
Sprinklers
Shutters
Generator
Sq. Ft. of First Floor:
Block No.
Windows/Doors
Roof
Cost of Construction: $ C/ z 6 Utilities: _ Sewer _ Septic Building Height:
Name dZ4ZIOZ a 41eA e&
Address 7/al l✓ ��t�cc�
City: C' + State: A.i
Zip Code: /17e S Fax:
Phone No. o %- %&'/
E -Mail
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: Curtis SO_wr )on S
Company: C,As-am A c S�Sfems NL
Address: lip l S S E d
_J
City: Vc p 7 ST Lkc kc-- State:
Zip Code: 342SZ Fax: ' 7; 33S ! I L
Phone No. _ 771 33'5 "3 3 2
E -Mail: C If- S r.c ) ' �
State or County License: Cfl C o 5 IS /O
If value of construction is 25el3or more, a RECORDED Notice of Commencement is required.
7S-00
NNUM,
Jame:
kddress:
:ity: State:
rip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: State:
City:
Z;p: Phone:
I
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: _Not Appllcab e
Name: Name:
Address: Address:City:
City:Phone:
Zip: Phone: Zip:
OWNER/ CC) AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
ONT
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
ylaws or and c v it holder
r I may rild estsubject
etbor prop bit 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
WARNING TO OWNER: Your property.
A Noticeof Commencement imust be recencement ordeduand posted ongtheice for
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 recorMg,your Notice of Commencement. ^ A
Signature of owner/ Agent/
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this Id day of _3�d2016 by
Signature of Contractor License Holder
STATE OF FLORIDA
COUNTY OF
eRT15 MOA s
(Name of person acknowledging)
(Signature of Notary Pu ic- Sta of Florida )
Personally Known '� OR Produced Identification
Type of identification Produced CHRISTINE B. ENG
�
���� �� * MY COMMISSION # EE
(/-�
Commission No. EXPIRES: April 4,
A"o' ' Bonded ThN Budget Notary
'
The forgoing instrument was acknowl 20gbefore me
this / day of
(Name of person acknowledging)
(Signature *Notaryublic- State Florida )
Personally Known OR Produced Identification
Type of identification Produced r0'. •YOB CHRISTINE B. ENGLISt
JSH 6� J j ` 7 �)MY COMMISSION # EE 8592
59 b1mmission No. ° * EXPIRES: April 4, 2017
P17 "I' OF Fld'§3 Bonded Thru Budget Notary SeM
REVIEWS FRONT ZONING SUPERVISOR REVIEW
REVIEW
ISO
COUNTER REVIEW
)ATE
DATE
COMP
VEGETATION I SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW