HomeMy WebLinkAboutBUILDING PERMIT.PPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 15-19- ILP
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:
Permit Number:
Building Permit Application
Commercial
Address: y 3 �i S CaC�.S Pat -I,, I 1 n• G��1 G
Legal Description:
Residential
Property Tax ID #: ,34 19 530 of C) i - ObO " I Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
L �1�P /Z.�� L/�� - ��D✓ l yJPc/ c /Ja�S� riL�L' /0/C
Block No.
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
— Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ __.�1 / 0 —
Nam
Q.
Address: 5CN r( iN &P1 ek wee_ 0+
City: I..O os -w i e State:
Zip Code: 3 bb S of Fax:
Phone No. 'J'13.- FS 8'0 $
E -Mail:
Generator Roof
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: !'urtt5 So mrnon —�
Company: CAAs-rym Vc �!1Isfes kic.
Address: t( IS S E T i I FwN Dr
City: Po -c S`C Lkc te State:
Zip Code: 34U52) Fax: '7 7a 335 l UE
Phone No. 771
E -Mail: (Lu sfo - ( Co )'C'm
State or County License: Cfl C 0 5 IL!O
If value of construction is 25edor more, a RECORDED Notice of Commencement is required.
EER: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone: _
_ Not Applicable
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
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 record4g your Notice of Commencement /1
Signature of Owner/
STATE OF FLORIDA
COUNTY OF S4- l_1?ei
The forgoing instrument was acknowledged before me
this J�L day of 20J_k by
(Name of person acknowledging)
12A4Z, X/ 'J4PU�
( ig ature of Notary Publi tate of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
MA DEBRA L. JOrt
Commission No. C Faa75 � 5 * x MY COMMISSION # F
EXPIRES: Septembe
REVIEWS FRONT ZONING SUPERVISOR
COUNTER REVIEW REVIEW
DATE
DATE
COMI
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF C' C
The forgoing instrument was acknowledged before me
this day of 20_oby
IC' b y-'s"X_
(Name of person acknowledging)
Aignature�&NotaryPu lic- S e of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
i�qsnmission No. Ef a r15
2019
1 '..
PLANS VEGETATION SEA TURTLE
REVIEW REVIEW REVIEW
DEBRA L JONES
*) MY COMMISSION # FF 22
EXPIRES: September 5.
MANGROVE
REVIEW