HomeMy WebLinkAboutBuilding Permit Application,.3PLICABLE INFO MUST BE COMPLETED FOR APPLICATION'TO BE ACCEPTED
Date: % �h
Permit Number:
Building Permit Application
Planning and Development Services
Building end Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
)ERMIT APPLICATION FOR:
address: o1 � �-�6 /Z
Legal Description:
Residential/
Property Tax ID #: ✓ �C?`'� �C S Lot No.—
Block No.
Site Plan Name:
Project Name:
Back: Right Side: __ Left Side:
Setbacks Front
itiona wor to be performed under t is permit - c eck all that apply:
Gas Tank Gas Piping Shutters
Mechanical _ — —
Electric _ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ -S-735---
—
7.35
— Sprinklers — Generator
Sq. Ft. of First Floor: —
Utilities: —Sewer _Septic
Name I�)a d LC6LL-oLe Ivfv r
Address: 9390 cciaerrt Ccs
City: V0lti i !' �. uL ► state:
Zip Code: J,4 R 5 Fax:
Phone No -__L7 -
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Windows/Doors
Roof
Building Height:
Name: ('_urtt5 S
Company: C,,Ac-r jjv A t'c st- SteM
Address: t St S S i; N r I I Dr
City: Pop -T �T Luce State: �L.
Zip Code: 34 �-521' Fax: `77a .335 1 �i6
Phone No.
E -Mail: C 'fi Ir c )
State or County License: Cfl C 05 1
If value of construction is�2S9dor more, a RECORDED Notice of Commencement is required.
t
NEER: —
Name:
Address: State:
City:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: — Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address: State:
lip:
ZPhone:
ip.
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 Count makes no representation that is granting a permit will authorize,ws r and cove ants thatt maydrtestrictsubject
o Proh bit such
which is in con id with any applicable Home Owners Association rules,
structure. Please consult with your Home Owners Association and review Your deed for any restrictions which may apply.
in all respects, perform the work
In consideration of the granting of this requested permit, I do hereby agree that I will,
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 recorftg your Notice of Commencement. 1 k
A
Signature of Owner/ Agent/ Lessee
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledges re me I
this ' day of
(Name of person acknowledging)
(Signature of Notary Public- St of Florida )
Personalty Known , OR Produced Identification
Type of identification Produced CHRISTINE B. E
MY COMMISSION 1
Commission No.� ` EXPIRES:April
gybed Thr Budget Nc
Signature
Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instr ent was acknowledOged by re me
this �_ day of
T
14,
(Name of person acknowledging )
(Signature of Notary Pu ic- Stat Florida )
Personally Known / OR Produced Identification
Type of Identification Produced
�R
ILISH
8ffil9fimission No.
2017
Services ''F ^•
� PLANS
REVIEWS � FRONT ZONING � COUNTER I REVIEW S REVIEW R REVIEW
DATE
CHRISTINE B. ENGLISt
Y COMMISSION # EE 8592
EXPIRES: April 4, 2017
VEGETATION 15 TURTLE
E MANGROVE
E
REVIEW REVIEW