HomeMy WebLinkAboutBuilding Permit Application.PPLICABLE INFO MUST BE COMPLETED FOR APPLICATION' TO BE ACCEPTED
Date: 1—U-11
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 1z
Address: tpOOb i ybib D2
Legal Description:
Property Tax ID #: 3L4 D Z — l0 1b - 0 393 - OC» 1 Lot No.
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Block No.
Mechanical _ Gas Tank ^ Gas Piping _ Shutters _ Windows/Doors
Electric _ Plumbing
Total Sq. Ft of Construction:
_ Sprinklers _ Generator _ _ Roof
Sq. Ft. of First Floor:
Cost of Construction: $ _.? /G/ — Utilities: _ Sewer _ Septic Building Height:
Name �I `�l( -, I +.~R �1�`Q, L@ -'--GLO
Address: -4,54>0—' es 'N2. __
City: F r i- P,'e r r -e- state: Fl -
Zip Code: 3V Mal -I Fax:
Phone No. 712 a 49 7 —
E -Mail
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: ( Uctl5 _Sa_mrnon S
Company: Cto-rd wl Fair S' ' S fe ms I Ai L
Address: �( IS S& 9Jr I(uav Qren D i, "
City: Pc e.T ST Luo f State: FL.
Zip Code: 34 USI Fax: 7U 335
Phone No. `77, 33,5 -3x3.2
E -Mail: C fc�' r c 1
State or County License: CA C 05 1S !O
If value of construction is 2590'or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LA
i
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: - Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
City:
Zip: Phone:
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 bylaws
rules, 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 i Ing your Notice of Commencement.
36
Signature of Owner/ Agent/ Lessee
Signature of Contractor License Holder
STATE OF FLORIDA.
STATE OF FLORIDA
COUNTY OF / ��
COUNTY OF 'A �Gc ✓c e
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this Le day of r G�.r1�i a- 20 jJ by
this 1—p- day of J Ln o o n 20_11 by
r
rnmanS
��tr�+s 5 H/rtrrlcil�
(Name of person acknowledging )
zai��
(Name of person acknowledging )
—
(Signature of Notary Public- St to of FI ida)
(Signature ' of Notary Public- State of Flo a )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification Produced
Type of Identification Produced.
CHRISTINE B. ENGLISH
Commission No. :'EJfff.�V4/* e}IPYC0MMISSION#EE8592
EXPIRES:
°` L`- CHRISTINE B. ENGLISH
"-Commission No. al)kIYCOMMISSION#EE 85928.
EXPIRES: April
April 4. 2017
s, 4; 2017
Bcnd=d
<uF Ft�z Bonded Thr Budget Notary Servic
s FOF fIOQ� Thru Budget Notary Service
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