HomeMy WebLinkAboutpermit application,PP ,UCABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: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 #:
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
� 1�te ��� t Ll �T t, `f �'°�^ /ySr�r C�PnSe 0 ✓� /off+,./
Lot No.
Block No.
lona wo to pe rmed unser tnis permR – umim. au air•
Mechanical _Gas Tank Shutters Windows/Doors Generator Roof Gas Piping _. —
_ Electric Plumbing _Sprinklers _ —
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ ' Utilities: _Sewer _Septic Building Height:
Name REn-e Ye
Address:_ y�C flu D
City: -ni2T r �uC'I state: L
Zip Code:Fax:
Phone No.
E -Mail:
FII in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: Curtls S un on S
Company: us-rbrit ��r ��is�ewc C.
Address: CVr 1 - n R Dr -_
City: QoLikc G State: #
Zip Code: 34 S -Z Fax: 2D 1 )X26
Phone No.
E -Mail:
state or County License: CA C o 5 1810 5� �
If value of construction is 2SP8(lor more, a RECORDED Notice of Commencement is required.
7•-00
EER: — Not
Name:
Address:CityState:
Zip: Phone:
Zip:
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:
d
)WNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicate.
certify that no work or installation has commenced prior to the issuance of a permit..
bylaws or and covenants that may restrict or prohibit such
t. Lucie County makes no representation that is granting a permit will authorize the permit holder to build the subject structure
vhich is in conflict with anY applicable Home Owners pssoaation rules, our deed for any restrictions which may apply.
fracture. Please consult with your Home Owners Association and review y
n consideration of the granting of this requested permit, I do hereby agree that I will, in all respects, perform the work
n accordance with the approved plans, the Florida Building Codes and St. Lucie County Amendments.
room additions
The following building permitplools, fences, walls, signs, rooms and accessory uses tications are exempt from undergoing a full concurrency review:
accessory structures, swimmingg p other non residential use
twice for
WARNING TO OWNER: Your failure toRecorce d
commencement Coe me� be recordedmerit result
uand posted on the twice
for e
improvements to Your property.
ion. If you intend to obtain financing, consult with lender or an attorney before
before the first inspect
commencing work or recor ' our Notice of Commencement. ^ A
Signature of Owner/ Agent/ lessee
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowled0ged before me
this day of
i'CR j, SO M n'lert
(Name of person acknowledging)
(Signature of Notary Public- 5 of Florida )
Personally Known
OR Produced Identification —
—
Type of Identification Produced SPRY Pae cHFUsnNE S. ENG
Signature of Contractor License Holder
STATE OF FLORIDA 1Z
COUNTY OF it
The forgoing instru nt was acknowledged before me
this � day of 20- by
L% I1 MY COMMIS
Commission No. E J * EXPIRES: April 4, 20
Bonded Thru Bud No1nry Si
REVIEWS FRONT ZONING S REVIEW R
COUNTER REVIEW
DATE
DATE
COMP
(Name of person acknowledging)
(Signature of Notary Public- tate of Florida )
Personally Known OR Produced Identification
Type of identification Produced <`: CHRISTINE B. ENGI
H v MY COMMISSION # EE i
gdommission No. S� o) EXPIRES: April 4, 2
Banded Thru Budget Notary
PLANS I REVIEW
VEGETATION
REVIEW S REVIEW E MREVIEWVE