HomeMy WebLinkAboutBUILDING PERMIT APPLICATION.PPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Planning and Development Services
Building end Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Permit Number:
Building Permit Application
Commercial Residential
Address: c3 1 o 8 Pejoble be-&cK 1 a�sZ-
Legal Description:
Property Tax ID#: 34a5 • ri615- C>0Lk2-
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Mechanical
Electric
rtormeo under
_ Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
Name Qo,+ r I e- ii
permit - cnecK an u,aL dNNly.
_ Gas Piping _ Shutters
_ Sprinklers _ Generator
Sq. Ft. of First Floor:
Lot No.
Block No.
Windows/Doors
Roof
??"S -o Utilities: _Sewer _Septic Building Height:
Address: J' I uZ5 I- cAh MlQcccc'13 ��•�
City: ' of ve State: EC'
Zip Code: c3 LAI 5-1 Fax:
Phone No. -
E -Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: &AALS Ison S
Company: AA5 A ('c Sui S he
hts �>V G
Address: I( t S S E T i l (at a r rt D, -
City: VoeT ST J-kQe- State: L.
Zip Code: 34'-52) Fax: ' 7,1 335 )ILL—
Phone
I6 FPhone No.
E -Mail: (Lu Sfi0, 1 r o)
State or County License: CA C 0 5 1e? 1 C)
If value of construction is?,S9dor more, a RECORDED Notice of Commencement is required.
DESIGNE
Name: _
Address:
City:
Zip:
Phone:
State:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name: _
Address:
City: _
Zip:
Phone:
MORTGAGE COMPANY:
Name:
Address:
Citv:
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 thepermit 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
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Rev. //Lu14
Signature of Owner/ Agent/ Lessee
Signature of Contractor License Holder
STATE OF FLORIDA<
` ;' '
STATE OF FLORIDAJe��
COUNTY OF
COUNTY OF J
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this LL day of O ` I 20 - by
this J day of %<" 2016 by
�"✓���� ��ry'tr,�>i.S
�'✓res _Sa/r�r���d��.
(Nameof rson ackn edging)
(Name of pefton acknowI ing�
(Signal d of Notary P I' State of Florida )
(Sig L ure of Not Public- tate of Florida)
'.�._R Produced Identification
Personally Known
II Known �- OR Produced Identification
Personally
Type of Identification Produced /
Type of Identification Produced
•• VIS
♦MY P di11'AES JARVIS
�� S �:
*1,1WSSION
'2 2 - G ISSION ai FF 014539
Commission No. / �/yS.� * RES: May�5, 201
Commission No. *( # FF 014539
EXPIRES: May 5,2017
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' ,��d' sondedTin8e qet ry
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. //Lu14