HomeMy WebLinkAboutBUILDING PERMIT APPLICATION.?PLICABLE INFO MUST BE COMPLETED FOR APPLICATION' TO BE ACCEPTED
Date: o -3 -( �e 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: 3$2.1 "AA(':lko— C+
Legal Description:
Property Tax ID #: L4 A5 - gbLp --b l 3LP -ocb - 3
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Side: Left Side:
Lot No.
Block No.
rl5���.r��i loft
_Mechanical _ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction:
Cost of Construction: $
Sq. Ft. of First Floor: —
Utilities: _ Sewer _ Septic
Windows/Doors
Roof
Building Height:
Name C,0••r6lhrn C_hG,PQe_�� Name: CurttS Sa.Vmrnon S
Address: 3$:rLk QLC- 0..-C`Company: (uSTroN1 Lr S�tSfems AICD
City: State: Address: lie I S S `y t I (aQ Q ren D,
Zip Code: 3 4 - :
0►�Jc3' Fax: City: �0�7 �T Luce State
Phone No. SS 3 -UoCQ- l Zip Code: 34 �&Z Fax: � U J3S
E -Mail: Phone No. 77�_
Fill in fee simple Title Holder on next page ( if different E -Mail: CIISTG it s S '0 C'0
cr
from the Owner listed above) State or County License: CA C 05 I � /O
II
if value of construction is 24W or more, a RECORDED Notice or commencement is requireu.
7,5-v D
s
_ Not
Name:
Address:
City: State:
Zip: Phone:
MORTGAGE COMPANY: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable I BONDING COMPANY: _Not Applicable
Name:
Address:
City:
Zip: Phone:
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 recoroi*g your Notice of Commencement 4
Signature of Owner/
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this A day of , c�c1_Q_ . 201 by
t� e_ �✓ er i.i.0 l.. 0 CJI �u
(Name of person acknowledging)
Signature of Notary Pu - State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced
Commission No. FF2�h5'i5
REVIEWS
DATE
COMPLETED
FRONT ZONING
COUNTER REVIEW
DEBRA L JONES
* MY COMMISSION i FF 2
EXPIRES: September 5,
SUPERVISOR
REVIEW
Signature of Co
STATE OF FLORIDA
COUNTY OF
Holder
The forgoing instrument was acknowledged before me
thisday of o r�A 201lc.by
(Name of person acknowledging)
(Signature of Notary Publi ate of Florida )
Personally Known I OR Produced Identification
Type of Identification Produced
�mmission No.
019 A
PLANS VEGETATION SEA��
REVIEW REVIEW REVIEW
DEBRA L JONES
MY COMMISSION f FF 22'
REVIEW