HomeMy WebLinkAboutBuilding Permit Application.v')PLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: CC -15.- 111
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
PERMIT APPLICATION FOR:
Address:
Legal Description:
Property Tax ID#: 3y1`')
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Residential
Lot No.
Block No.
nnr�4 e(�_y
Mechanical
_ Electric
_ Gas Tank
Total Sq. Ft of Construction:
Plumbing
Cost of Construction: $ H S15C Q
_ Gas Piping
_ Sprinklers
Shutters
_ Generator
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic
Name I_-ef',,
Address: 1 11--1 SE C'. C-�-i -� i>d 2
City: State: F L -
Zip Code: .3LkCr50 Fax:
Phone No. 111 - _531s' -"GSA
E -Mail
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Windows/Doors
Roof
Building Height:
Name: Lurt15 So-mrnorl S
Company:
&A5TM41 VC Lisfelms
kjG
Address:
i(e l S S�_
D,-
City: Po
T ST LuC «
State: FL.
Zip Code:
342&L Fax: 77a
J3S
Phone No.
7 7�_ 53,5-3Q2-
3,5"3Q2-
E-Mail:
E-Mail:
Lu talk' S�l - '0 C'o 1 Ccr.
State or County License: CAC05 i,� JO
S�0-le
if value of construction is2.5e _or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: _ Not Applicable
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 recordiVg your Notice of Commencement. /17
Rev. 7/2014
Signature of Owner/ Agent/ essee
Signature of Contractor License Holder
STATE OF FLORIDA
�L°!�'
STATE OF FLORIDA
COUNTY OF
COUNTY OF J'�
The forgoing instru nt was acknowledged before me
The forgoing instrument was acknowledged before me
this day of 20_ by
this day of 20_ by
IX
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary Publi State ofoorida)
(Signature of Notary Public- State of F rida )
Personally Known OR Produced Identification
Personally Known k__'Ci R Produced Identification
Type of Identification Produced
Type of Identification Produced GHRI6:RNE 0. SH
.Pay PU
Commission No. G'!rep FW _/ 11P .• - 11 1 CHRISTINE B. ENGLISH
85928
# * MY COMMISSION # EE 85928
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Commission No:' al) EXPIAES:Apri14,2017
*geaMYCOMMISSION#EE
EXPIRES: April 4, 2017
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014