HomeMy WebLinkAboutBUILDING PERMIT APPLICATION,PPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I
Planning and Development Services
Building and 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 t1.
Address: �3Lk
Legal Description:
Property Tax ID #: �- kLC' " �3 �1�� -
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
ki
z ZD j/te. 'S �o �l,Etl!sc Ov"r /j St -G( S--/,
Lot No.
Block No.
d-ition-al work to beperrormea unaertnispe�iii�i-.������,••���rrr
'Mechanical — Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
Electric _ Plumbing _ Sprinklers _ Generator _ Roof
Total Sq. Ft of Construction:
Cost of Construction: $
Sq. Ft. of First Floor:
Utilities: —Sewer _ Septic Building Height:
Name N'f je M I,SCQQ 4'f' J -)ct --
Address: t-( -:
City: Lz- -k R o c C'? _ State: �Cr
Zip Code: 3`tG Fax:
Phone No. -S�skk
E -Mail
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: Ct_Lrtt5 Savnmon
Company: GAs-Fem V« )AJC.
Address I(e lS S �I r I lec�rcn
City: VcQ7 ST LuCkf— r _-State:�L.
Zip Code: 34�51 Fax: 17; LS i t6
Phone No. 171 33,5 " 3 �-3 2
E -Mail: L '1 r c
State or County License: Cfl C 05 I S !O
If value of construction is 2sAo'or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: — Not Applicable
Name:
Address
City: _
Zip:
Phone:
State:
FEE SIMPLE TITLE HOLDER: — Not Applicable
Name:
Address:
City:
Zip: Phone: _
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
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 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(;4Vg your Notice of Commencement.
Signature of Owner/ Agent/
Signature of Contractor/License Holder
STATE OF COUNTY OF FLORIDA GRID
�f l vCt e � � y I COUNTY OF
The forgoing instrument was acknowledged before me
this 25— day of20_1 '' by
(Name of person acknowledging )
The forgoing instrument was acknowledged before me
this ?_ -3 day of 1'1eC'eMloe7 , 20(= by
`t?
(Name of person acknowledging)
(Signature of Notary Public- State of F1906 (Signature of Notary Public- tate of '16rida )
Personally Known OR Produced Identification Personally Known ✓ OR Produced Identification
Type of Identification Produced
Type of Identification Produced YP
pnY
�" P' B<RISIINE B. ENGLISH L/ �° : CHRISTINE B. ENGL&
Commission No. E y'% '":"'• , �S COMMISSION#EE 859284 Commission No.�� , a*I tftCOMMISSIONNEE8592E
* * EXPIRES: April 4, 2011 EXPIRES: April 4, 2017
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REVIEWS FRONT ZONING SUP[RVISOR PLANS VEGETATION SFA TU RTI F MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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