HomeMy WebLinkAboutBuilding Permit ApplicationY
.PPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: "1e7
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:
7r 1
Permit Number:
Building Permit Application
Commercial Residential
Property Tax ID #: gJ'�/- V C,�'/%%mc ^V/- Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ 7 - 6�
Name
Generator Roof
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
Address: 7 V tilde"
city: /00a State: FL
Zip Code: Fax:
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: Curtis - aC uMrnon S
Company: Cas-rb►n R t r- ��J S fe VnS )AJC-
Address:
AyGAddress: tI IS S E T i l ( ag Q r,,erL D,- -
city: Po Z is -r LkC t State: FL
Zip Code: 34252) Fax: '7,; 33S 1 t6�
Phone No. 771
E -Mail: cu Sfi4tr, Cu 40 ) -c.crn
State or County License: Cfl C o 5 IR 10
ff value of construction is 2.S9Tor more, a RECORDED Notice of Commencement is required.
le
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: _
Address:
City: _
Zip:
Phone:
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 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 nci
applicable Home Owers Assoation rules, bylaws or and covenants that may restrict or 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 ail 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 recordi*g your Notice of Commencement. ,Q
Signature of Owner/ Agent/
Signature of Contractor/License Holder
STATE OF FLORIDA ��,, STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 4f day of 20 /6 by this_LL day of Sv,.v 20 1 b by
CvR is SAMrnorlS LURTLS S11-mrnoA5
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public- State lorida) (Signature of Notary Public- Stat Flori
Personally Known " OR Produced Identification Personally Known `y, of OR Produced Identification
TT of Identification Produced Type of Identification Produced
ype r 1pav pie
*�`,•Fue4c` CfRisN
B. NEotaryS5CHRISTINE BE COMMISSION #EE e9
W EE8$mmision No.E85��8
Commission NO.E 005 A0_1l
N EXPIRES: April4; 2017n rnddThruBudgetEXPIRES: April .20
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE a���P� PLein CHRIS NE B. E
COMPLETED * * MISSION #EE 859284
Rev. sq ��Q dEXPIRES: April 4, 2017
aF o Budget Notary Services