HomeMy WebLinkAboutBuilding Permit Application.PPUCABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 7-1d:;;W Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address:
Legal Description:
Property Tax ID #: rya y Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
//ate z9( L.11f e ,3-f / '✓C' _�-/i t"J
Additional workto performed unser inis permR – LnrtR aII u'aI,°1YY'1
> Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator — Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer _ Septic Building Height:
Name Au fid 12�4LL
Address: �d'��6 ,SliSS�X AUV
City: State: D{.
Zip Code: 14 y�tvl. Fax*
.—
Phone No. Lfe"2 – �•��� _/7���
E -Mail
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: Curt(s S'C.Mrnon.5
Company: CIU rd rm R t r C.
Address: 1, e t S S& T1 11 r-
City:Pow Lkc i- State: rL.
Zip Code: _3425�) Fax:
Phone No. 771 33,s - 3 �_3'2-
E-Mail: CU 1, o )
State or County License: 2 C 05 18 !O 5� �
If value of construction is 25AIfor more, a RECORDED Notice of Commencement is required.
75-00
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:
)WNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
certify that no work or installation has commenced prior to the issuance of a permit..
>t. Lucie Countv makes no representation that is granting a perm it will abylaows or and covenit ants thatt maydrtestrictbor subject
bit such
which is in conflict with any applicable Home Owners Association rules,
traduce. 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 permitI 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-resident for
WARNING TO OWNER: Your failure to tice Record a Notice of Commencement be recordedresult
uand posteour d inngt w j e for
site
improvements to Your property.
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. ^ A
Signature of Owner/
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this Id day of 20 /6 by
eyR t is �l�mmo
Signature of
(Name of person acknowledging) I
(Signature of �N�otaryublic- State lorida )
Personally Known OR Produced Identification
Type of Identification Produced ,Pa
ao �.••, �•� CHRISTINE B. ENG''
E E iSga 004 ; )* MY COMMISSION k EE
Commission No. EXPIRES: April 4.2
s9* *_r , ;oo< Nonded'hri Budaat Nntary
Holder
STATE OF FLORIDA s'z ► e
COUNTY OF
The forgoing instrument was acknowledged before me
this day of Sv ,. 20 I b by
C4 LS Si+mrnoA S
(Name of person acknowledging)
(Signature of Notary Public- Stat of Flori
Personally Known v1 OR Produced Identification
Tvc>e of Identification Produced ---
107"U51
E E � sqa 8� �Y COMMIS�
mission No. * EXPIRES: App 4, 2017
Bonded Thru Budget Nota y Sem
� PLANS
REVIEWS FRONT ZONING � I COUNTER I REVIEW SUPERVISOR REVIEW REVIEW
DATE
COMPLETED
VEGETATION SEA
URT E MANGROVE
REVI W E REVIEW
CHRIS NE B. E
* * MISSION t EE 859284
EXPIRES: April 4, 2017
s 9 OF 4`a,` Bonded 11hru Budget Notary Services