HomeMy WebLinkAboutBuilding Permit Application,PP LICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 Residential
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial
PERMIT APPLICATION FOR:
Address: :�3qq Cra" PQI� IDr
Legal Description:
Property Tax ID #: 34125 %U y 000
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
alI
11 1/tP /Z.?r 11ke- CoA 01'AtNs e- � yse [ /o?,
Alechanical
Electric
Total Sq. Ft of Construction:
Gas Tank
Plumbing
perMI'E — cnec
_ Gas Piping
_ Sprinklers
apply:
_ Shutters
Generator
Sq. Ft. of First Floor:
Lot No.
Block No.
Windows/Doors
Roof
Cost of Construction: $ % Utilities: _ Sewer _ Septic Building Height:
Names(S..n n cJ l�� cin �crc��� • •—
Address: 3q ?J (f t—abGZeig )2. ze----
City: / r,)C/ � State:
Zip Code: , 3g95Q Fax:
Phone No. �%%� - / 6059 /
E -Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: curds S' vw on S
Company: CAus-rdm A 'r uS eims iUC,
Address: I(IS Si; 11II'a� ren
City: Vc_� L." C I _ State: FL.,
Zip Code: 34 9 Fax: 'iia 33S 1 `tb
Phone No. 772 315 -3232
E -Mail: C A3, kr- 01.
State or County License: CA C 05 I? /D SS40A19-
If value of construction is 2 eO'or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
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
bylaws that may restrict or such
which is in conflict with any applicable Home Owners Association rules, or and covenants prohibit
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 recor our Notice of Commencement.
Signature of Owner/ Agent/ Lessee
Signature of Contractor License Holder
STATE OF FLORIDASTATE
COUNTY OF 31Y LUcl e_ aoUr-74C-I
OF FLORIDA C1
COUNTY OF J 1 LucI C
J
The forgoing instrument was acknowledged before me
The for oing instrument was acknowledged before me
l.'�' /o
this day of (�n_ f DbL' r 20 by
this. -,3e day of 66 r 20 I by
Cvr� �S ,S0,MIX7&
Cvr -13 6a mino r75 ,
(Name of person acknowledging)
(Name of person acknowledging)
( ignature of Notary Pu ic- State of Florida)
(Sign lure of Notary Publi tate of Florida )
Personally Known OR Produced Identification
Personally Known `� OR Produced Identification
Type of Identification Produced
Type of Identification Produced
�t;A �P� DEBRA L ,IONS
Commission No. ��02?7�7J� I)
MY COAIISSION # FF 22
��o�o17$ 7j(� L JONES
Commission No. �A�IISSION#FF 717575
15 * *
* *
EXPIRES; September 5,
19 r, o� EXPIRES: September 5, 2019
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REVIEWS FRONT ZONING SUPERVISOR
PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.