HomeMy WebLinkAboutBUILDING PERMIT APPLICATIN.?PLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
D `_' " l Permit Number:
Date:
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:
vv'C_ 1
Property Tax ID #: <3`rt a Z r _ ` Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Block No.
ditional work to be perrormeo unaer -Erns permit - cnF:cR a.. a wL aF+F+Iy-
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: $ 51 tC�5 F CID Utilities: _ Sewer _Septic Building Height:
Name i i`
Address: t � � N- cu
City. � ` > State: f_L
Zip Code:Fax: nn
Phone No�'��
E -Mail
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: LUrt(S Sa MPY)On S
Company: C,us-re�,m A:'c Se Nns
Address: 9J I (ur ren T
City: Vc T ST U0C- State: FL.
Zip Code: 34M Fax: 7'1a 33S 1�6
Phone No. 7 71 33,5 -3�-3 �
E -Mail: CutifiQ�r < u 49 G -C 1 c.cm
State or County License: CO C 0 5 1 lO S lam
I If value of construction is 2seor more, a RECORDED Notice of Commencement is required. I
7 IDD
T
DESIGNER/ENGINEER: _ Not Applicable
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:
Name:
Address:
0tv.
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. Luce County makes no representation that is grantingg a permit will authorize the permit holder to build the subject structure
which is in conflict with ar�Y applicable Home Owners As�ocration 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
commencine work or recordivit vour Notice of Commencement. /7
Signature of Owner/ Agent/
STATE OF FLORID
COUNTY OF \ 'L� k-
The forgoing in ent was acknowledged before me
this 1 _ day of 20(�.` by
0-I -r�y 'D
(Name of person acknowledging)
(SigriattSre of Notary Public- Stal�(of Florida )
Signature of Contractor[Ucense Holder
STATE OF FLORIDA
COUNTY OF _3 `
The forgoing instr ment was acknowledged before me
this day of 20 1 �Cby
0 V) r N"\0T D
(Name of person acknowledging)
G�
(Signature of Notary F -Atite of Florida)
Personally Known "- OR Produced Identification Personally Known l-- OR Produced Identification
Type of Identification Produced Type of identIM-ation Produced
Commission No. f'Fni� g5'1fJ `;:�(`° I) DEBRAL.JONES Commission No. r �t7S`i5 aP�;pY•�;° a_ I) DEBRA L. JONES
MY COMMISSION # FF S 75 * * I COMMISSION # FF 2275°,
* * EXPIRES: September 5, 19 EXPIRES: September 5,20 ; `i
' A»Rre e a ryrv� ave
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
RECEIVED
DATE