HomeMy WebLinkAboutBuilding Permit Application.PPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: l
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: %ala�n�/GAS
Legal Description:
Property Tax ID #: ✓V i J '121'o , ffr - Y
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Lot No.
Block No.
ditional work to be pe
_Mechanical
Electric
rmea unser
_ Gas Tank
— Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
– cnecx a
_ Gas Piping _ Shutters
_ Sprinklers _ Generator
Sq. Ft. of First Floor:
Windows/Doors
Roof
q (11 I "�? • 001 Utilities: _ Sewer _ Septic Building Height:
Address: //
City: G/L y- State: f
Zip Code: 6j, Fax:
Phone No. �Vs OZ11/��
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: ('urtt5 Sct mrnon S
Company: C',us-r'm ur 5!�Sfems )/UG
Address: l (Q l S S E it i t (Or, e Flr- N
City: CCS Z S T L1t C r State: �L
Zip Code: 34�S)�, Fax: `77a J36' i UE
Phone No. 772 3315 "3�3
E -Mail: C" .9fi 1� Su CSC) C cm
State or County License: Cfl C o 5 IS 10
If value of construction is 25edor more, a RECORDED Notice of Commencement is required.
e
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: 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
or and permit
coveholderants at mayrestricta subject
structure
h bits ch
which is in conflict with any applicable Home Owners Association rules,
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 recorcj�qg your Notice of Commencement.
Signature of Owner/
STATE OF FLORIDA p
COUNTY OF .�/ �''' �—�
The forgoing instrume t was acknowledged before me
this, day of 20 by
(,,v S S J i �l1 i�i1 L� �If
(Name of person acknowledging)
S
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification Produced o��:•: B� CHRISTINE B. E .1 Z,
MI wrMnIrwo
*(S�(pIRES. April 4, 2017
Commission No. °� P n^+IlWoi mM �•"`°`
'Apar• r.°''
REVIEWS FRONT ZONING
COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF L7_r
The forgoing instrument was acknowledged before me
this ' day of 1 20_ by
SL(CS,S S"n'kno"2__)
(Name of person acknowledging)
(Signature of NotaryPublic- State of orida )
Personally Known �/ OR Produced Identification
Type of Identification Produced �tPav pie ruatenn,G
_ * MY COMMISSION # EE 859'
Commission No.L P (S(NARES: April 4.2017
r+rFOF F71eO Bonded Th nu Budget Nctery er:ic
SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW