HomeMy WebLinkAboutBuilding Permit ApplicationV '
,PP LICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: i - I - I ('�Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 f'
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address:
Legal Description:
Property Tax ID #: L} - '� O \ - do 1 L - C%UO - ( Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Z -Mc r�A rse- // 0
_Mechanical _ Gas Tank
_ Electric _ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $j / S
_ Gas Piping _ Shutters _ Windows/Doors
_ Sprinklers _ Generator _ Roof
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
Name L:A , (s� n cL 2> o`5 "cz-- 7%(V -P
Address: ���1 �r\cll"�n �OC, �-Cc"
City: ? ^ r t --)t- L -- c_ce v State: f=
Zip Code: 3` l `� �- Fax:
Phone No. c'Z 15 - S -7 7
E -Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
If value of construction is 2GAdor more, a RECORDED Notice of Commencement is required.
Name: Curtis SC1.MMOn S
Company: �� S f LS
)Iv c.
Address I(e l5 S ren
D,
City: PC 9.-T �T L�tC if
State: �L
Zip Coder Fax: 71a
33S 1 �t6
Phone No. 77')33.5 �3�32
E -Mail: CltSfigtr, Sit V ac ) •(,cm
State or County License: Cfl C 0 5 I R 10
S� P
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
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants that may restrictor 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 recor ' R your Notice of Commencement.
Signature of Owner/ Agent/ lessee Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this r day of i , I -, , 20_ by
SC'_ V
(Name of person acknowledging)
(g
Si nature of Notary Public -'State of Florida )
STATE OF FLORIDA
COUNTY OF 5+ Ls:'C_X
The forgoing instrument was acknowledged before me
this day of 20 -- by
J
Cu( -t - SC- .�,m6n5
(Name of person acknowledging)
( ignature of Notary Publ�State of Florida )
Personally Known OR Produced Identification Personally Known • OR Produced Identification
Type of identification Produced Type of Identification Produced
DEBRA L JONES
i ra � s '-7 Sip Commission No. �� ' '' iW OOMMISSIO # FF 227575
Commission No. 4 ; )) pEgq LJONES
* OnRES; &ftw 5, 2019
MY COMMISSION t FF 515 +,� lowt No�tY Swrka
1 R
kWWTW Natry.e
REVIEWS FRONT ZONING SUPERVISOR $LANS
COUNTER REVIEW REVIEW REVIEW
DATE
_RECEIVED
DATE
COMPLETED
Rev. 7/2014
VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW