HomeMy WebLinkAboutpermit application.PPLICABLE INFO MUST BE COMPLETED FOR APPLICATION'TO BE ACCEPTED
Date: ,2- tc`t -14
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
Address: Lkqt)1 fny1f+ke' bQ-
Legal Description:
Commercial Residential
Property Tax ID #: 31400, LoO$ -' `b�Lk� " bcX)O'9 Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Block No.
1�k4-e_ �c�v,, 3 loll ILA `seer 1G1�C>,.� Ilea. -l.
itiona work to be pertormed under this permit - check all that apply:
Mechanical _ Gas Tank _ Gas Piping _ Shutters
Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction:
Cost of Construction: $ tA P50
Name 4 n4 el A.
Sq. Ft. of First Floor:
Windows/Doors
Roof
Utilities: Sewer _ Septic Building Height:
Address: 4g001 my ricAP Dfl-
City: F ccs P t e. rc e- State: F
ZipCode: 3t Ck& Z. Fax:
Phone No. '1r12- ' Sh � - Tc CsO
E -Mail
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: (Urtl5 ' gO_Mrnon'5
Company: W5 -Pm Vc S�' eimNc-
Address: (iplS Si; 9Jr
City: PC_L-� 5T LkC tr- State: �L
Zip Code: 349 Fax: E;
Phone No. 33,5 "3a3l
E -Mail: fiq 01
State or County License: Cfl C 0 5 ) S /O
If value of construction is 2690'or more, a RECORDED Notice of Commencement is required.
DESIGNI
_ Not Applica
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
MORTGAGE COMPANY:
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY:
Name: _
Address:
City:_
Zip:
Phone:
Not Applicable
State:
Not Applicable
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, fentes, 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
commencinia work or recor 'g your Notice of Commencement.
V_
Signature of Owner/ Agent/ Lessee
Signature of Contractor License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF ,) 7� We I e e Cbc-,n+
COUNTY OF
The for oing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this 1'A day of bCCeMloe_. , 20 1 {G by
this 1(:'i_ day of L'f.Cf_rnbef 201b by
aur > 0
(Name of person acknowledging)
(Name of person acknowledging )
(Signature of Notary Public- State o (orida)
(Signature of Notary Public- St to of Flori )
Personally Known •/ OR Produced Identification
Personally Known L - OR Produced Identification
Type of Identification Produced
Type of Identification Produced
CHRISTINE B. ENGLIS
u ?� ,•
Commission No. �� •57 * I)MYCOMMISSION#EE8592
/ `
�pRY P
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4 ommission No. ': •'•eal)CHRISTINEB.EWUSH
EXPIRES: April 4,2017-I""-
* MYCOMMISMNIEE859284
Bended Thr4 Budget Notary Servi
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014