HomeMy WebLinkAbout1609-0174„3PLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
/o2 _/� Permit Number:
Date:
CC3:J 111"i -T Y
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
Building Permit Application
Commercial Residential
Legal Description:
Lot No.__
Property lax ID #: � u15 -� � � � Block No.
Site Plan Name:
Project Name:
Setbacks Front__
Back: Right Side: _Left Side:
,-�lAA5e- O
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Mechanical
Electric
Gas Tank
_ Plumbing
Total Sq. Ft of Construction: /1
Cost of Construction: $ % 3r-
Cost
Gas Piping
_ Sprinklers
Generator
Sq. Ft. of First Floor: —
utilities: _Sewer _ Septic
Name �SaUGtnlYi �I�b ltvH Address: State:
3��a- C'u�''�-;�'' ”
�� R.� �+- F, � r,�o _State: F L
City: 340 05 d,
Zip Code: 34 R Sa-• Fax:
Phone No. 34c) 188`
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Windows/Doors
Roof
Building Height:
Name: Gurus Sa4n on S
Company: liASTcoN1 ASfelL')S , J�
Address: l� 15 S N r I Dr
City: VState:
o z �T LLLc i
Zip Code: 3495 Fax: `i'7a �3S 1`26
Phone No.
E -Mail: C t Ir c)
State or County License:
If value of construction is^2,s9(ror more, a RECORDED Notice of Commencement is required.
i
DESIGNER/ENGINEER:
Name:
Address:
City:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
— Not Applicable
State:
Not Applicable
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
striucture. Pleasle consult w with Hlome Owners Assoc Association land rerulview your deed ocovenants restrictions
which may astrict 6r . prohibit such
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
hpfnrP the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work .or recor your Notice of Commencement.
Signature of Owner/ Agent/ lessee
Signature of Contractor License Holder
STATE OF FLORIDA
STATE OF FLORIDA 1,
COUNTY OF ,S�f '/�`c
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrum nt was acknowledged before me
day e (c Iry 206 by
this day of 20 by
this of ,
71 J
(Name of person acknowledging)
(Name of person acknowledging)
1,7
(Signature of Notary Public- State of orida )
(Signature of Notary Public- State of orida)
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification Produced
Type of Identification Produced
I "gee, (�71NE B. ENGLISH
Commission No. r ' ��' ° NIISSIONIIEE859284
J SPRY rUB
r� Q ye° ".' RISTINE B. ENGLISH
Commission No. S/� ( eMMISSION#EE85928o
*
EXPIRES: April 4, 2017
t EXPIRES: April 4, 2017
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REVIEWS FRONT ZONING SUPERVISOR
PLANS VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW
COUNTER REVIEW REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
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