HomeMy WebLinkAboutBUILDING PERMIT APPLICATION,PPLICABLE INFO MUST BE COMPLETED FOR APPLICATION°TO BE ACCEPTED
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Date: li k' Permit Number:
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: f' ;
Legal Description:
Building Permit Application
Commercial Residential
r� 5
Property Tax ID #: � / - � ���-� Lot No.
Block No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Name CgR&ICus 4 Sy k" Van de br(,t161'2
Address:(floe ro(MWeq 10 'Ygq � (}
City: �h-kS Lc�n� 00000 1�ethe 5 lCt1 LI Wl
Zip Lode Fax:
Phone No. '77a- 873-05/
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: (urtl5 S m ort S
Company: Ctk5 rdm A AJC-
Address: �(elS S� `Urinca� r
City: o 9 7 T LkCtiC- State: FL
Zip Code: 34 �&?) Fax: `17o7 .335 1 i6
Phone No. 771 335 "332
E -Mail: C To'Jr- c )
State or County License: Cfl C 0 5 IS !O S �a �
If value of construction is256tlor more, a RECORDED Notice of Commencement is required.
AdCfltio--naT—work to a pertormea
under trils
permit - c ec
a t at app y:
Mechanical
_Gas Tank
_Gas Piping
— Shutters
— Windows/Doors
_ Electric
_Plumbing
Sprinklers
_ Sp
— Generator
— Roof
Total Sq. Ft of Construction:
Sq. Ft. of First Floor:
Cost of Construction: $
—
Utilities: _Sewer _Septic
Building Height:
Name CgR&ICus 4 Sy k" Van de br(,t161'2
Address:(floe ro(MWeq 10 'Ygq � (}
City: �h-kS Lc�n� 00000 1�ethe 5 lCt1 LI Wl
Zip Lode Fax:
Phone No. '77a- 873-05/
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: (urtl5 S m ort S
Company: Ctk5 rdm A AJC-
Address: �(elS S� `Urinca� r
City: o 9 7 T LkCtiC- State: FL
Zip Code: 34 �&?) Fax: `17o7 .335 1 i6
Phone No. 771 335 "332
E -Mail: C To'Jr- c )
State or County License: Cfl C 0 5 IS !O S �a �
If value of construction is256tlor more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: — Not Applicable
Name:
Address
City:
Zip: _
Phone:
State:
FEE SIMPLE TITLE HOLDER: — Not Applicable
Name: _
Address:
City:
Zip:
one:
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 Countfly makes no representation that is granting a permit will authorize the permit holder to build the subject structure
structurin e. Please consult any
lurr Home Owners Assoc trs ion Association
rerulviewybylaws deed or any restrictions which may arict or pply. 'bit such
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 recorS! >Tg your Notice of Commencement /I
Signature of Owner/ Agent/"Lessee
Signature of Contractor�License Holder
STATE OF FLORIDA STATE OF FLORIDA .v
COUNTY OF 31f-��'-�� COUNTY OF � of _61.1 e
The forgoing instrument was acknowledged before me
this c�day of 0-,& 20 1- by
(17L1 % / S f� /n lno /!S
_
(Name of person acknowledging)
(Signature of Notary Public- State of Flor' )
Personally Known OR Produced Identification
Type of Identification Produced
CHRISTINE B. ENGLISH
Commission No. ell yyCOMMISSION#EE 8592E
*
EXPIRES: April 4, 2017
Bonded Thru Budget Notary Servic
REVIEWS FRONT I ZONING
, COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
The forgoing instrument was acknowledged before me
this x `` day of ; 20_ by
(Name of person acknowledging)
(Signature of Notary Public- State of Flo ' a )
Personally Known V --"-OR Produced Identification
Type of Identification Produced
v CHRISTINE B. ENG11S
Commission No. LrrEl�syolr�y aIJ MY COMMISSION# EE 859
EXPIRES: April 4, 201;
Bonded Thru 9udgot Notary Sery
SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
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