HomeMy WebLinkAboutBuilding Permit Application.PPLICABLE INFO MUST BE COMPLETED FOR APPLICATION'TO BE ACCEPTED
Date: 1o2 -/1 -/,? Permit Number:
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:
Building' Permit Application
Commercial Residential
Address: S ,[fake V/ eo ell- I'°Z 03
Legal Description:
Property Tax ID #: / �� Jr 6 oino4- ff -0`1'
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Lot No.
Block No.
%fee �Z�r Lllz e 3 oti i yseer /0 C'���:, �_ p ✓i ' k t,,./
V Mechanical Gas Tank
_ Electric _ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $
_ Gas Piping
Shutters
_ Sprinklers _ Generator
Sq. Ft. of First Floor:
Utilities: _ Sewer _ Septic
Name %�Q m1 J m 'Co9erj -
Address: NN
City: X e 'Cad'. State:
Zip Code: a a 1 6 Fax: 465-35_( 0
Phone No. 4bk- F02o 0
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Windows/Doors
Roof
Building Height:
Name: �Urtt5 S0.vnmon S
Company: m Vr- � j S fe m s
Address: Ile l S S �- 9 rwrt
D,-
,City:
City:o e T ST LAC i ,C_ cl
State: �L
Zip Code: 34 Fax: T11
33S 1 td �
Phone No. 77,E 33,5 '.3�_3 �2-
E-Mail: CUSfi4lr �L, : V C'0 l l,cr\
State or County License: CA C 05 IS !O
If value of construction is 25Kor more, a RECORDED Notice of Commencement is required.
MORTGAGE COMPANY:
Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name:
Address:
City:
Zip: Phone:
Not Applicable
BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
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, 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 ' g your Notice of Commencement.
Signature of Owner/ Agent/Lessee Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The for oing instrument was acknowledged before me
this I day of bC.Ce.Mbe.: 20 1(G by
(Name of person acknowledging )
(Signature of Notary Public- State oa orida )
Personally Known �11 OR Produced Identification
Type of Identification Produced
STATE OF FLORIDA
COUNTY OF__5k-�-
The forgoing instrument was acknowledged before me
this _�L2L day of _L"f.CCmlQcf , 20 t to by
(Name of person acknowledging )
(Signature of Notary Public- State of Flori7
Personally Known L-�" OR Produced Identification
Type of Identification Produced
Commission
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CHRISTINE B. ENGLISH
COMMISSION p EE 8592 ;
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No.
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EXPIRES: April 4, 2017
w * My COMMISSION# EE 859284
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Bended Thr Budget Notary Semi
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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