HomeMy WebLinkAboutBuilding Permit Application,PPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: � .� l- 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: ,1J�C(o f Z�,� -,&z ,
Legal Description:
Property Tax ID #: 142S_" �0 5-, ������ —1 Lot No._
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
di onal work to be performed under this permit — check all that apply:
Mechanical _ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction:
Cost of Construction: $
Name lluali a Anil -t610_1 & 10 CC k4
Address: A101 C' qri� I& .fle d
Sq. Ft. of First Floor:
Windows/Doors
Roof
Utilities: _ Sewer _ Septic Building Height:
City: State:
Zip Code: 41VUoZJ Fax:
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: eUrtl5 Sxwrnon ,�
Company: C',us-r&?M Vr sli S fe ms )&I c
Address: ll I S SE Ti I (° a Q reeN D, -
City: Po T�L T L k C r State: FL.
Zip Code: 342SL Fax: '77a 33S
Phone No. 771 33,5 "332
E -Mail: (Lu st4if- Sig ^ V iic 1 (IM
State or County License: U C 05 IR /O
If value of construction is 2.SA10ror more. a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: — Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
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
bylaws that may restrict or such
which is in conflict with any applicable Home Owners Association rules, or and covenants prohibit
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 'g your Notice of Commencement.
16
Signature of Owner/ Agent/ Lessee
Signature of Contractor License Holder
STATE OF FLORIDA/�
STATE OF FLORIDA ,o
COUNTY OF ,0000
COUNTY OF �( G'e
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this day of 20by
this >-�/ day of 20L by
(Name of person acknowledging)
(Name of person acknowledging )
(Signature of Notary Public- State of Florida)
(Signature of Notary Public -State o orida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification Produced
Type of Identification Produced
Commission No. �� � yd �y �o PaY PL a11CHRISTINE B. ENGLISH
MMY COMMISSION # EE
�M':. P&4/
Commission No. ��O ✓` �v�o 7 * TSe RISTINE B. ENGLISH
* * OMMISWN # EE 859284
* * 85928
EXPIRES: April4, 2017
EXPIRES: April 4, 2017
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of F
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es
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014