HomeMy WebLinkAboutBuilding Permit Application„3PLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
Building Permit Application !
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce F! 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address: l "A ,z> z A
Legal Description:
Property Tax ID #: d-Jrf– 707 e�/ -006— () Lot No.
Site Plan Name:
Project Name:
Block No.
Setbacks Front Back: Right Side: Left Side:
L1119e-'- qf�A lySee� G1A0Sc, '01117 -
Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator Roof
Total Sq. Ft of Construction:
Cost of Construction: $
Sq. Ft. of First Floor:
Utilities: —Sewer _Septic Building Height:
Name F-'Z41d/ WOW ' C
Address: 15'5�23
City: &„,, Z� State: OR
Zip Code: Y7065 Fax:
Phone No.66'S��J•�� 17
E -Mail
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: �urtt5 Savnrnon S
Company: CAA -ryni L(- S� S fe MS NL,
Address: i (e l S S& T, Ho
City: Poi Q. ST L kC �C- State:
Zip Code: 34 �&)-, Fax: '77a J35- E
Phone No.
E -Mail: C U ST(tlr SL4 V” ac 1 i,cfi
State or County License: _ CAC 05 is !O
If value of construction is 2.%Kor more, a RECORDED Notice of Commencement is required.
7
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 record4vR your Notice of Commencement. .,
01-Y Zt
Signature of Owner/ Agent/ Lessee
Signature of Contractor License Holder
DESIGNER/ENGINEER: Not Applicable
Name:
Address:
City: State:
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
City:
Zip: Phone:
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 record4vR your Notice of Commencement. .,
01-Y Zt
Signature of Owner/ Agent/ Lessee
Signature of Contractor License Holder
STATE OF FLORIDA
COUNTY OF ��f
STATE OF FLORIDA
,��
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this Z_�- day of E�� 20� by
this ,. — day of d - 201, �- by
ed k TS IJ --A in Pyl 6 n S
(Name of person acknowledging)
(Name of person acknowledging )
(Signature of Notary Public- Statp6f Florida)
(Signature of Notary Public- State of Pericla )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification Produced
Type of Identification Produced
CHRISTINE B.ENWSH��
Commission No. C_ c M SSION # EE 859284
* i
EXPIRES: April 4, 2017
Commission No. 2�\'�MMISSiON # EE 659284
Sy�
�1
IRES: April 4, 2017
Services
Bonded Thru Budget Notget
ntTr Notary Serrice:
Bonded Thru Budary
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
J. V..iI_vi�