HomeMy WebLinkAboutBUILDING PERMIT.PPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 5-18 -1(P
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 Residential
Address:
Legal Description:
Property Tax ID #: 'tea►® 9 Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
nal wo
_Mechanical
Electric
_ Gas Tank
_ Plumbing
permit-
-
ermit—
_ Gas Piping
Sprinklers
_ Shutters
_ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ � 73Utilities: —Sewer _ Septic
Name �b IQS �L
Address: AH (c$ LA 4-c'e wr- Cp\Le. D(Z-
City: �=er-i- P erce. State: _L
Zip Code: 340t `-t 1 Fax:
Phone No. 510 I u ' A9Lo5
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Block No.
Windows/Doors
Roof
Building Height:
Name: ('urtt5 Sawrnon S
Company: Is-rom A« LlSfehls )IQ C,
Address: 1, e l S S& Ti I ' ca.� Q r Dr
City: PC -c ST l..ttCie State: L.
Zip Code: 34 51 Fax: `17a J35- ) X2L
Phone No. 771 33,5 "32-32
E -Mail: CuSfiQIf- ,,u � V ao) I -,M
State or County License: U C 05 IR lO
If value of construction is ISBdor more, a RECORDED Notice of Commencement is required.
Name:
Address:
Citv:
Zip: Phone:
_ Not Applicable MORTGAGE COMPANY: — Not Applicable
Name:
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 9
ermit holder to build the subject structure
structurin e. Please consult w with yo r Home Owners Association
andrreviebylaws
y ur deed focovenants
a y restrictions tions wh restrict
h ay 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 recordog your Notice of Commencement 9
Signature of Owner/ Agent/
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this It day of � 20_Llf by
(Name of person acknowledging)
( ignature of Notary Public- State of Florida )
Personally Known ✓ OR Produced Identification
Type of Identification Produced
Commission No. r �oZo�'7�J15 �� DEBRAL.M
MY O MMISSM t FF
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
COMP
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this i t3 day of TYI&A-A . 20�p( by
(Name of person acknowledging)
(Signature of Notary Public- Sta a of Florida )
Personally Known OR Produced Identification
Type of identification Produced
Commission No. FF�,'15'1S �."'{�eal) DEBRALJONES
* , * My COMMISSO i FF 72717,
80*1IM IMWpt Nata Senkm
SUPERVISOR PLANS
REVIEW REVIEW
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VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW