HomeMy WebLinkAboutBuilding Permit Application.PPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: / -�
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:
,?S -ed to l /10
Permit Number:
Building Permit Application
Commercial Residential
Property Tax ID #: 2 yob% // / - 0 ^ Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Block No.
L llf� 1�r LilZc .3 T�� /yster /°�'
Windows/Doors
_ Electric _ Plumbing _ Sprinklers — Generator _ Roof
Total Sq. Ft of Construction:
Cost of Construction: $ o
Sq. Ft. of First Floor:
Utilities: _Sewer _Septic Building Height:
Name 11�n�nt'J yr��
Address: /6'S CG2 .� ;76
- r
City: p o�11 � ���1 � State: rl—
Zip Code: 305Fax:
Phone No. r�7- / f�
E -Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: c'urtc5 S'Cmrnon S
Company: 1< out Ric ��Sfems )/Qc
Address: t! I S SS -
City:
ECity: V0 -r ST LkC State: FL.
Zip Code: 34M Fax: 77a 336- )161
Phone No. _ 7 �� 33 S -3Q1
E -Mail: L r 01.
State or County License: S ake
If value of construction Is 2591Tor more, a RECORDED Notice of Commencement is required.
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
— Not Applicable
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 Counnnttflyyy��makes no representation that is granting a permit will authorize the ppermit holder to build the subject structure
structure. in Pease consult withpyourr Home Owners owners
on and reviewyourdeed orcovenants
any restrictions may
`Nhich may apply prohibit such
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 recorrfiVg your Notice of Commencement.
Signature of owner
STATE OF FLORIDA y%L yU�e� e
COUNTY OF ' '
The forgoing instrurne it wps acknowledged before me
this day of /�. 20,[ by
-7-15 *In neo P�
(Name of person acknowledging)
(Signature of Notary Public_ State lorida )
Personally Known OR Produced Identification
Type of Identification Produced
CHRISTINE B. ENO
Commission No.L�s " MY COMMISSION t EE I
#_ * EXPIRES: April 4, 2
REVIEWS I CFRONT OUNTER I ZONING REVIEW I S REVISOR
DATE
COMI
Signature of Contractor%License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument a acknowledged. before me
this°! day of CL� 20r by
A/0 �IU�1S�
(Name of person acknowledging)
(Signature of Notary Public- ate of rida )
Personally Known ,AOR Produced Identification
Type of Identification Produced °
�� *0V"
I,IY COMMISSION N EE
mmission No. GrEXPIRES: April 4,
"' Bonded nn: Budget Notary
PLANS VEGETATION 5E REVIEW E MANGROVE
REVIEW REVIEW