HomeMy WebLinkAboutBuildling Permit Application?P,LICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 2-6 _ i (4Permit Number:
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
)ERMIT APPLICATION FOR:
Building Permit Application
Commercial_. Residential
4ddress: C—
Legal Description:
Property Tax ID #: 332- - - b(� f� - vCu
Lot No.
Block No.
Site Plan Name:
Project Name:
Back: Right Side: Left Side:
Setbacks Front
HQUILWIItli wv1n — — r"•--•••'__ -
Gas Piping Shutters Windows/Doors
Mechanical — Gas Ta
Electric nk _ P g —
Plumbing — Sprinklers — Generator _ Roof
— g
Total Sq. Ft of Construction:
Sq. Ft. of First Floor:
Cost of Construction: $ ��^ Utilities: —Sewer _Septic Building He
Name l✓�we rCl , CC�� h �c tLs✓ G�I
Address:
City: State: Ny
Zip Code: + Fax:
Phone No. T12
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
If value of construction isZ,59dor more, a RECORDED Notice of Commencement is required.
-
Name: ('_u(-tL5 Sam on S
Company: C„5 -rvj!3 A « S't S fe Vns � D
Address: i (e I S S�- �) r l (' �
City: PC — ST L4c�e- State: FL.
Zip Code: 34 95-d, Fax: TI33S 1 c16
Phone No. 771 H'i ~L3 2-
E -Mail:
State or County License: CA C 0 5 ) R l
Name:
Address
City: —
Zip:
EER: _ Not Applicable
Phone:
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
Not Applicable
State:
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 structuin re. Please consult w with applicable
lome Owners Assocl tion aond review your deed or any restr thatmay
wh ch marestricty al. 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
before the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recorS!�Tg your Notice of Commencement /J
Signature of Owner/ Agent/ Lessee Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF .S71 L u cl r' 01v Y'
The forgoing instrument was acknowledged before me
this .2 day of S� �20 by
e/—✓r_0 _S .5A Alm
(Name of person acknowledging )
(Signature Notary Public- S e of Florida )
Personally Known I,// OR Produced Identification
Type of Identification Produced .P0.Y Pis 1r1ld�9 d7t1�1R6
* * MY COMMISSION * FF 014539
Commission No. ILAY SealtXPIRES: May 5, 2017
+rE�noa`O
Bonded ThruBudget Notary Senim
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
STATE OF FLORIDA tuoc Co✓icy
COUNTY OF—
The forgoing instrument was acknowledged before me
this Z day of _5cfr . 20L by
(Name of person acknowledging)
4
(Signattyr,�of Notary R lic- State of Florida )
Personally Known � OR Pro kidentificattiion
lJAMES JAWS
Type of Identification Produced °
* .. , * 014539
Commission No. /lZ yy S�1 "',W (S IRES: May 5, 2017
f os n� hru B diet NoWy Senior
SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW