HomeMy WebLinkAboutBUILDING PERMIT APPLICATION,PPLICABLE INFO MUST BE COMPLETED FOR APPLICATION"TO BE ACCEPTED
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:
Address:
Legal Description:
,�7
Permit Number:
Building Permit Application
Commercial
Property Tax ID #: JY,) 11 - �10 Aw Y M -0
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Residential
Additional work to be performed under this permit - check all that apply:
Mechanical _ Gas Tank _ Gas Piping _ Shutters
_ Electric _ Plumbing _ Sprinklers _ Generator
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 7 7 Utilities: —Sewer _Septic
Name limo+tIJ
Address: �7��i ���� � �'"�
City: Stater
Zip Code: Ali I `l Fax:
Phone No. 3V 72 ,
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Lot No.
Block No.
Windows/Doors
Roof
Building Height:
Name: ('urtl5 Savnmon
Company: � A r S fe ims ) &J C,
Address: ( t S�- T
City:yok7 ST L-1kc State: FL
Zip Code: 34�-5 2) Fax: `7'7,1 �L- S
Phone No. 7 7J- 33,5 ' 3 �J —
E -Mail: C Ta, r c I
State or County License: CA C o 5 I S !O S�a e
If value of construction is 2400 -or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: _ Not Applica
Name:
Address
City: _
Zip: _
Phone:
State:
MORTGAGE COMPANY: — Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable I BONDING COMPANY:
Name:
Address:
City:
Zip: Phone:
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
commenciniz work or recordim>? your Notice of Commencement. /?
Rev. 7/2014
Signature of Owner/ Agent/ essee
Signature of Contractor license Holder
STATE OF FLORIDA
STATE OF FLORIDA
,o
COUNTY OF ,.5�/�-1G�
COUNTY OF _"
Theforgoing instrume t was acknowledged before me
The forgoing instrument was acknowledged before me
this day of20,, by
this �:' day of i 20 by
71J- 0 %lw ,71, f
((i
���� TS J,
(Name of person acknowledging)
(Name of person acknowledging)
Z-521
(Signature of Notary Publi - State of rida)
(Signature of Notary Public- ate of rida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
on
Type of Identification Produced aY Pu
&pe of Identification Produced
* MY COMMISSION # EE
Commission No. EXPIRES: April 4,
59284 p 2�SP!Y'•.e C CHRISTINE B. ENGLISH
2 1�ommission No. EC1 9,0 l S,e, 8 COMMISSION # EE 859284
Bonded Thru Budget Notary
ervices a EXPIRES;Apri 4, 2017
Bonded Thru Budget Notary Services
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014