HomeMy WebLinkAboutBuilding Permit Application.PPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: G' -,�p �' Permit Number:
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:
Address:
Legal Description:
Building' Permit Application
Commercial Residential
Property Tax ID #: ��� (7- �CY ��i'rJ7 -wed � Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Block No.
Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
c
Cost of Construction: $ -� Utilities: _ Sewer _ Septic
Name Q
Address: _
City: /f �l�t�x� State: L_/
Zip Code: <O(p J % Fax:
Phone No.
E -Mail
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Building Height:
Name: CurttS So_ vnrnon S
Company: CAAs T m A ("r
Address: I(IS S � Ti 1(aQ �F�n Di
t
City: e T ST LuC i� State: L.
Zip Code: 4 2-52) Fax: '77a J 35
Phone No. 77� 33,5 -.3)-3 2
E -Mail: CuSfiAIr "!4 se CLc
State or County License: CA C 05 i,? 10 Slate,
I if value of construction is 2r or more, a RECORDED Notice of Commencement is required. I
7�510 D
Not
Name:
Address
City:
Zip: Phone:
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
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 recorcjnpg your Notice of Commencement
Signature of Owner/ Agent/
STATE OF FLORIDA
COUNTY OF liltZZZ
The forgoing instrument was acknowledged before me
this ' day of 20 - by
144' �lj ym2 fy�'J
(Name of person acknowledging)
(Signature of Notary Public- State of Florida )
Signature of Contractor%License Holder
STATE OF FLORIDA%—��C
COUNTY OF c�
The forgoing instrument was acknowledged before me
this :, day of G c 20 16 by
(Name of person acknowledging)
z�7�
(Signature of Notary Publi - State pOlorida )
Personalty Known !� OR Produced Identification
Personally Known OR Produced Identrincatron T pe of identification Produced
Type of Identification Produced xY moo" .B C_ CHRISTINE B. ENGLISH
No. �L �S�
MY COMMISSION it EE 59284 ��5 y��Cf
EXPIRES: A ril4, commission No.
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"Y COMMISSION 4 EE 85928,
EXPIRES: April 4, 2017
Commission
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Bonded Thru Budget Notewe
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Bondad Thru Budget Notary Sery ce
SUPERVISOR PLANS VEGETATION SEATURTLE
REVIEW
REVIEW
MANGROVE
REVIEW
REVIEWS FRONT ZONING
COUNTER REVIEW
REVIEW REVIEW
RECEIVED
DATE
COMPLET