HomeMy WebLinkAboutBUILDING PERMIT APPLICATION.PPUCABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 7 � 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 #: LL2 7 7ty 4r^�Y,e
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
l //1 r c- o S�h
i Mechanical
_ Electric
Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
permit — check all tnat appy
_ Gas Piping _ Shutters
_ Sprinklers _ Generator
Sq. Ft. of First Floor:
Lot No.
Block No.
Windows/Doors
Roof
Cost of Construction: $ ?� Utilities: _ Sewer _ Septic Building Height:
Name 1esl.e Harrotoel- d .Iehn lSllt-er
Address: �-W i nA41 ?ten,
City: ei� � State: Al
Zip Code: <<i��ZO Fax: 7�-��'
Phone No.
E -Mail
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: Curft5 So'wrnon S
Company: (',us-rdm Ate SteMs IilC-
Address: Ile l S S& T' l (a a Q r Dr "
City: Pc97 S T Lt(e i c - State: FL.
Zip Code: 3495 Fax: ' 7; J3, ! �
Phone No. 7V 33,5 "3a
E -Mail: (L s�',uS V c -C
State or County License: Cfl C 0 5 ►,� /� 5� �
if value of construction is zsAtfor more, a RECORDED Notice of Commencement is required.
e
Name:
Address:
City:
State
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:
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 repretatior meatOis wners�Association rules, will bylaows or and cove ants that mayla testi subject
o proh bits ch
which is in conflict with any applicable
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 '
our Notice of Commencement. ^ w
1 1111
Signature of Owner/ Agent/lessee
STATE OF FLORIDA/J�
COUNTY OF u �C
The forgoing instruent was acknowledged before me
this day of -6e, 20// b by
(Name of person acknowledging)
C- 1 _ �
(Signature of Notary Public- State of Flo a )
Personally Known — OR Produced Identification
Type of Identification Produced
CHRISTINE B. ENCU
Commission No. �� y
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
*) MY COMMISSION # EE 85!
EXPIRES: April 4, 201
Signature of Contractor license Holder
STATE OF FLORIDA —�
COUNTY OF%
The forgoing instr e�alcknowledged before me
this day of2�` =- by
(Name of person acknowledging)
(Signature of Notary Public- of da )
Personally Known � OR Produced identification
Type of ldentification Produced 6 PAY
�E CHRISTINE B. ENGLISi
Commission No. # I)MY COMMISSION # EE 8592
EXPIRES: April 4, 2017
I r9''oF .l�Po %100A2d ThN BudceNOt2fY S�
Ka mrce'
SUPERVISOR PLANS VEGETATION SEE �I E MANGROVE
REVIEW REVIEW
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