HomeMy WebLinkAboutBuilding Permit Application.?PLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: //"�`�
Planning and Development Services
Building and Code liegulotion Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
PERMIT APPLICATION FOR:
Address: JI50
Legal Description:
Permit Number:
Building Permit Application
Commercial ResidentialL
�J'a��- %�>' ,__
Property Tax ID #: �
Lot No.Block No.
Site Plan Name:
Project Name:
Setbacks Front
Back: Right Side: Left Side:
Windows/Doors
Mechanical
Electric _ Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction: / Sq. Ft. of First Floor:
Cost of Construction: $ U a Utilities: —Sewer _Septic Building Height:
Name �7.
Address:
City: �o� L`.Si��� State: t
Zip Code: e��/`��� Fax:
Phone No.
E -Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: CUrtts Savnmon s
Company: CUSTNim A'r ')LA S fe
Address: Ike l S S `U r 11 , "
City: V� bkc « State:
Zip Code: `� Fax: ' 7,4 335 I �6
Phone No.—
E-Mail: C fi e l
State or County License: Cfl C o 5 ► 10 S �a�
if value of construction is 259l:ror 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
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
commencing work or recorMg your Notice of Commencement.
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Signature of Owner/ Agent/ iessee
Signature of Contractor License Holder
STATE OF FLORIDA
COUNTY OF ,S�f ��/ G�—�
STATE OF FLORIDA
COUNTY OF
The forgoing instrume t was acknowledged before me
this L day of 20— by
The forgoing instrument was acknowledged before me
this 4 day of 20_ by
�66 IC 715 ✓Amon S
C_ i(r r S� �9rn m cin S
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary Public-tate of orida)
(Signature of Notary Public- State 9f7forida )
Personally Knowny OR Produced Identification
Personally Known ,PuOR Produced Identification
Type of Identification Produced Fa, FSB
p * MY COMMISSION # EE 8
Commission No. E f5�_ II V s EXPIRES: April 40,, 2(
9je,OF F� Bonded Thru Budget Notary S
Stype of Identification Produced Qs^: a F a,, nuo:enuS o r G 1 H
9284 E�S �� * * MY COMMISSION # EE 8592784
7Commission No. s al) EXPIRES: April 4, 2017
' es '+rFOF FLpa�� ronded Thri Budget Notary Smites
I
RFVIFWS
FRONT
COUNTER
ZONING
REVIEW
SUPERVISOR
REVIEW
PLANS
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VEGETATION
REVIEW
SEA TURTLE
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MANGROVE
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DATE
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DATE
COMPLETED
Rev. 7/2014