HomeMy WebLinkAbout1606-0431.RPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: � W/-/ �- 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:
Building Permit Application
Commercial Residential !'
Address: ��%��`Xe 7��/erd-
Legal Description:
Property Tax ID #: &WO IlLf
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Ike
12,r L/IQ-� V'PA �-X-QP5C '�'-J� / 1"/S -Pc l - /0
Lot No.
Block No.
'Mechanical
Electric
_ Gas Tank
Plumbing
Gas Piping
_ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ `7
LL—
Name
Address:
6 ra�
City: State:
Zip Code: Fax:
Phone No. °2, a5
Shutters
Windows/Doors
Generator _ Roof
Sq. Ft. of First Floor:
Utilities: —sewer _ Septic
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Building Height:
Name: (?lords Saummon S
Company: �,us-r&Jrn « �'� S fe h�S ��� c
Address: I (e l 5 S f; CV r l{ D,-
City:Vc�Lke« State:
Zip Code: _34 9-':iQ) Fax: 7'7o� :i35 1 �i6
Phone No. 771 IL "32-3 �
E -Mail: C fiA r Se '
State or County License: Cfl C D 5 I R lO
If value of construction is 200'or more, a RECORDED Notice of Commencement is required.
e
Not
Vame:
Address: State:
City:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: — Not Applicable
Name:
Address: State:
City:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
C'Ity:
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.
n applicable a Home Owners Association rules, bylaws or and covenants that may restrict or prohibit such
St. Lucie County makes
no representation that is granting a permit will authorize the ermit holder to build the subject prohibit
structure
which is in conflict w y PP
hich ma
structure. Please consult with your Home Owners Association and review your deed for any restrictions
wform the work apply.
In consideration of the granting d f this plans, Florida da Building Codes and St Lucie d permit, I do hereby agree tCounity Amendments•
in accordance with the app p
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 usestoanother
n your paying twice for
WARNING TO OWNER: Your failure to Record a Notice of Commencemi may
A Notice of Commencement must be recorded and posted on the jobsite
improvements to your property.
before the first inspection. If you intend to obtain
Commencement suit with lender or an attorney before
commencingwork or recor ' our Notice ^ n
Signature of Owner/ Agent/
STATE OF FLORIDA 1 rf
COUNTY OF
The forgoing instrume t was acknowledged before me
this . day of �� 20 l6' by
Cit R IS 'Sp rnm()n'S
(Name of person acknowledging)
(Signature of Notary Public- State of rida )
Personally Known _ OR Produced Identification
Type of Identification Produced
Commission No.
'SOF
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
Signature of Contractor License Holder
STATE OF FLORIDA �71
COUNTY OF
The forgoing instru ent was acknowledged before me
this day of 20 by
CHRISTINE B. ENC
* MY COMMISSION # EE
l yr\` ( lS : SAM 011
(Name of person acknowledging )
J
(Signature of Notary Public - State of FI ida )
Personally Known ✓ OR Produced Identification
Type of identification Produced EB ENG
V P
�� � °e, CHRISTIN
MY COMMISSION # EE 859
mmission No. Sj
% ' 1 0 " EXPIRES. April 4.201
Bon T'n'udge'*0"Ser'- VEGETATION SEA TURTLE MANGROVE
SUPERVISOR PLANS REVIEW REVIEW REVIEW
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