HomeMy WebLinkAboutBUILDING PERMIT APPLICATION.,PPLICABLE INFO MUST BE COMPLETED FOR APPLICATIONTO BE ACCEPTED
Date: r 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: �55ZC)
Legal Description:
Property Tax ID #:�� �c�,�� -" ��"' Q2J �Cx� "`-t Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back:
Right Side: Left Side:
ditional worK to be performed under this permit— Choc
Mechanical _ Gas Tank _ Gas Piping
Electric _ Plumbing _ Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $ C11C c m
_ Shutters
_ Generator
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic
Name
Address: '"( I-Vy p a=jC�CI kyO,
City: ( State: _(_\liiI
Zip Code: 1�t C) l Fax:
,
Phone No. -I 1 z q—q — 0--1
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Block No.
_ Windows/Doors
Roof
Building Height:
Name: Lurtts Savnrnon S
Company: (,As-r&,m Vc S�4,sfems )ijc
Address: I(QlS SE Nr Ilea,-Qr A Dr
City: P027 ST Luc ot_' State: FL,
Zip Code: 34�SZ Fax: ` 7; 335 1 �6
Phone No. 77.7 33,5 -30-32
E -Mail: CuSTOX- Su ac) -6m
State or County License: CA C 0 5 1,� /O S4ate "
I If value of construction is.Z58dor more, a RECORDED Notice of Commencement is required. I
7f'010
_ 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: _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 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 recordilog vourrecord' Notice of Commencement.
11 Rev. 7/ZU14
Signature of Owner/ Agent/lessee
Signature of Contractor License Holder
STATE OF FLORIDt.
COUNTY OF �� Li� ��t,1'
STATE OF FLORIDA�
COUNTY OF C�C
The forgoing in ent was acknowledge before me
The forgoing in ent was acknowledged before me
this �,day of 1C` 20� by
this day of 20_ by
(Name of person acknowledging)
(Name of person acknowledging)
A10 -VII C,, (-/
zzz2 6.6Z
(S ature c Notary Publi tate of Florida)
gn
Notary Public- a of Florida)
(Signature
of
Personally Known — OR Produced Identification
Personally Known OR Produced Identification
Type of Identification Produced
Type of Identification Produced
Commission No. 'r'a `1J` ,a`",".�::'�4Seal)DEBRALAONES
Commission No.l�l �� ��4; , pEW5
* ' * MY COMMISSION t FF 227571,
* * MY COMMISSION i FF 227575
REVIEWS
FRONT
c,Ace-`°
ZONING
ThtuBudgetNotaryServi,
SUPERVISOR
PLANS
"'� lls�leCThruBtN ry Service:
VEGETATION SEA TURTL E MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
11 Rev. 7/ZU14