HomeMy WebLinkAboutBuilding Permit Application.,'PLICABLE INFO MUST BE COMPLETED FOR APPLICATION' TO BE ACCEPTED
Date: 13 _5 I 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: 5H l Za--
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front
f llv
altlonal worK 1
'Mechanical
Back: Right Side
/z�r J_/1 -LP 3,�— 'f -.-,^
,rormea under
Gas Tank
_ Electric _ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
Left Side:
s permit –cnecK an tnat apply:
1ohi"
Lot No.
Block No.
_ Gas Piping _ Shutters — Windows/Doors
Sprinklers _ Generator _ Roof
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic Building Height:
Name " 0.V CLnn o,_ Cl to b w -P, _-Enc
Address: ---5q a1 0-f -0 Non j_ -Ole. _V-) P
City: �(9c'�- `� L)nkp, State: Vi(.
Zip Code: 3rIg95a Fax: G1
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: Curds �o_mrnon S
Company: Ca, -rpm Vc- ��Sfems )IVL
Address: 1( ( S S& cVi 1(u,,.a_ren Dr
City: PCS Q'7 5 T Lu C« r State: F"L.
Zip Code: 34q_% Fax: 77� J3S 1 t6 X
Phone No. 77,)- 33,5-3,�3.Z
E -Mail: CUsfia,tr- S� V C,c ) r,cr.
State or County License: CA C 05 1,� !D S �a
If value of construction is2?.W(for more, a RECORDED Notice of Commencement is required.
7S-1:10
MORTGAGE COMPANY:
Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
Not Applicable BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
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 applicable Home Owners Association 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 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 recor ' g your Notice of Commencement. n
Signature of Owner/ Agent/ lessee Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF a
The forgoing instrument was acknowledged before me
this day of V'5 20J , by
/t Wiry,
(Name of person acknowledgin
(Signatute of Notary Public-Atate of Florida )
Personally Known OR Produced Identification
STATE OF FLORIDAy L J(Je
COUNTY OF
The forgoing instrument wasAcknowledged before me
this day of Aa')L/,�> 20, ^ by
(Name of p n acknowledging)
f
(Signage of Notary P4 ic- State of Florida )
Personally Known OR Produced Identification
Type of Identfiptlon Produced Y P Type of Identification Produced
+t-ryc &V E8IN" 01111 •::4�. JAMES JARVI6
�;• ,r
pp p /y3 3T * MY COMMISSION i FF 0'14539 � jZ p / (� S' Y�jQMMISSION i FF 014539
Commission No. �) EXPIRES: May 5,20 7Commission No. * 'VIRES: May 5, 2017
u�rE ►3,e Banded NU BAA NMuy S kes ��,� Roe Ewded Thru B64gel Notary Senkes
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DATE
_RECEIVED
DATE
COMP
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