HomeMy WebLinkAboutBUILDING PERMIT APPLICATION.PPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
-��� Permit Number:
Date:/c
Planning and Development Services
Building end Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address: �l�y
Legal Description:
Building Permit Application
Commercial Residential
Property Tax ID #: LN2 �� �Ci7_ �°Zc��-��� /� Lot No.
Block No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
�A l c� QV �2
Shutters Windows/Doors
Mechanical _ Gas Tank _ Gas Piping _
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $`�
Name kv &'t
Address• �l,�y
Generator
Sq. Ft. of First Floor:
Roof
Utilities: _Sewer _ Septic Building Height:
City: �� t J� i <= State: ILI
Zip Code: �/�Sv� Fax:
Phone No. it I Z - fC� _ % 47 `i
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: Curtis Sa+mmon S
Company: (us rdm A t �� S femS ) C
Address: 1, Q IS S E I i I (Or, Q rain ��
City: PCL-'�- State:
Zip Code: 344 Sz Fax:
Phone No.
E -Mail:
State or County License: Cfl C 0 5 IR IO Sia P
if value of construction is 2500ror more, a RECORDED Notice of Commencement is required.
Not
Name:
Address: State:
City:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City.
Zip: Phone:
MORTGAGE COMPANY: ____ Not Applicable
Name:
Address: State:
Zip Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
Zip: Phone:
s indicated.
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation a
I certify that no work or installation has commenced prior to the issuance of a permit.
an applicable Home Owners association rules, bylaws or and covenants that may restrict or prohibit such
St. Lurie County makes no representation that is granting a permit will authorize the ermit holder to build the subject structure
which is in conflict with Y PP
may
structure. Please consult with your Home Owners Association and review Your deed for any restrictionhe work apply.
In consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform
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 erse� ea room other non-residential idential use
accessory structures, swimming pools, fences, walls, signs, screen rooms and accessoryuses
for
WARNING TO OWNER: Your failure t.Notice of commencement eme t�mus be recordedment result
uand posted on the joesite
improvements to your property.
before the first inspection. If you intend Not �obtain e of Commencement consult with lender or an attorney
commencin work or recor • ^ n
Signature of Owner/ Agent/
STATE OF FLORIDA
COUNTY OF �f�/ — —
The forgoing instrument was acknowledged by re me
this day of
Signature
Holder
STATE OF FLORIDA
COUNTY OF tel/
The forgoing instru ent was acknowledged before me
this day of 20= by
(Name of person acknowledging)
(Signature of Notary Pub's- State Florida )
Personalty Known /, OR Produced Identification —
Type of Identification Produced d.. cH N
MY COMMISSION # EE 8592
Commission No. �C # �) EXPIRES'. April 4, 2017
bonded Thru Budget Notary Servi
REVIEWS FRONT ZONING S REVIEWR
COUNTER REVIEW
DATE
G F' 7L �/ ,`��'1%NG /2
(Name of person acknowledging)
(Signature of Notary Pub ic- Stat Florida )
Personally Known ,--,"OR Produced identification
Type of Identification Produced "•"�� H
* MY COMMISSION EE 859284
4Commission No. $eafPIRES: April 4, 2017
s
9rFoFkoa banded Thru Budget Notary Sery es
VEGETATION SEATURTLE MANGROVE
PLANS REVIEW REVIEW
REVIEW REVIEW