HomeMy WebLinkAboutBUILDING PERMIT.PPLICABLE INFO MUST BE COMPLETED FOR APPLICATION' TO BE ACCEPTED
Date: '�_I�F _/( 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
PERMIT APPLICATION FOR:
Address: 3s�� SCc2 r L �z
Legal Description:
Property Tax ID #: y� 4 r%O� — �G— ��� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Additional work to be pertormed under this permit —check all that apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ .e_'
('/ , Utilities: _ Sewer _ Septic Building Height:
Name KcAaK& )LLs6Lnn
Address: 3�9 SCCA T ti Ct
City: PA 2-i S Z LL(r I C'_ State: rL
Zip Code: r34q 5,,2- Fax:
Phone No. 6Y%-6''�
E -Mail: 5eeren lqq{ eGrmcziI C.DW\-
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: Curfts SA.ki1mon S
Company: 15-rym Ur 5�1Sfems )Nc:.
Address: telS S& iii I Ic2G r n Dr
City: Po27 ST Luc C_ State: I`L.
Zip Code: 34 2_52) Fax: ' 7a
Phone No. 7 Z 335 -3 32
E -Mail: custa 1r, ¢!4 V o.o I i' m
State or County License: Cfl C 0 5 GR lO Sia-fe
II If value of construction is 2.aeTor more, a RECORDED Notice of Commencement is required. II
7 �O
It
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
Citv:
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 recor(�iVg your Notice of Commencement /7 i
Signature of Owner/ Agent/
STATE OF FLORIDA
COUNTY OF / �
The forgoing instrument was acknowledged before me
this day of 20 by
(Name of person acknowledging)
(Signature of Notary/Public- to of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
p . PUB(i CHRISTINE B. ENGLISH
Commission No.� „ !�ehIhCOMMISSION#EE 859284
EXPIRES: April 4, 2017
Boded Thru Budget Notary Services
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Signature of Contractor[License Holder
STATE OF FLORIDA
COUNTY OF Yy Lvc
The forgoing instrument was acknowledged before me
this ( day of ,d4 t; , , 20 /-by
((47-/ S 7l 1Y7 M 1/) 4'
(Name of person acknowledging )
� ,.
(Signature of Notary Public- State Florida )
Personally Known OR Produced Identification
Type of Identification Produced CHRISTINE B. SH
�7 I/.
��"W.-
SUPERVISOR
�o Y COMMISSION # EE 65928
Commission No. ��/ o / *EXPIRES: April 4, 2017
_4 Bonded Thru Budget Notary service
PLANS I VEGETATION SEA TURTLE I MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW