HomeMy WebLinkAboutBUILDING PERMIT APPLICATIONDESIGNER/ENGINEER: _ Not Applica
Name:
Address:
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: _
Address:
City: I City:
Zip: Phone: Zip: Phone:
MORTGAGE COMPANY: — Not Applicable
Name: _
Address:
City: _
Zip:
Phone:
BONDING COMPANY:
Name:
Address:
State:
Not Applicable
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
swhich tructurin e. Please consult with your Hlome Owners AssAssociation
iation and review your deed or any restrictions which aor
apply 'bit 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 record4g your Notice of Commencement /I
Signature of Owner/
STATE OF FLORIDA
COUNTY OF c1/11
The forgoing forgoing instrument was acknowledged before me
this day of20_ by
(Name of person acknowledging)
(Signature of Notary' Public- Statof Florida
/)
Personally Known /� OR Produced Identification
Type of Identification Produced
Paz Pie. CHRISTINE: a.
Commission No. ��� * MYCOMMISSION#F
EXPIRES: Ao,i'
REVIEWS I FRONT I ZONING
COUNTER REVIEW
TE
DATE
COMPLETED
Signature of Contractor%License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this day of 13�/A f 20/ 6 by
( �lRTS �!9 M S -
(Name of person acknowledging)
(Signature of Notary Public ate of rida }
Personally Known OR Produced Identification
Type of Identification Produced
5���� a� r•� s-nNE B. ENGLISH
Commission No. _° ( MMISWN#EEg59284
* * EXPiRES.Apri14,2017
SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW
.PPLICABLE INFO MUST BE COMPLETED FOR APPLICATION' TO BE ACCEPTED
Date: 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:
Legal Description:
y,,, ac Al/i/ A ,y,1 S
Property Tax ID #: �- ���"/Jr�" eye - '7 Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Block No.
'Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
Name )ca 11 , I'te&A,t
Generator Roof
Sq. Ft. of First Floor:
Utilities: —Sewer _ Septic Building Height:
Address: 7tcc<� L'
City: /�i���'� State: FL
Zip Code: U X 7-4 Fax:
Phone No. IpIr7- 702/-J _,�;s/7
E -Mail
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: �Urt(5 SO'MYnan S
Company: (',1511M �!�SfeMS )iJC.
Address: ll 15 S E i% i I (° G g r,.,r-- N D,-
City:
,City: 'Po T ST LikC IC_ State:
Zip Code: 342SZ Fax: `77a J3S 1 �E
Phone No. 771 336 "3x32
E -Mail: (Lu Sfi4ir SL4 (P ao).C'rm
State or County License: Cfl C 0 5 IR 10
If value of construction is 2490"or more, a RECORDED Notice of Commencement is required.