HomeMy WebLinkAboutBuilding Permit Application?PLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: `4 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:
Building Permit Application
Commercial
Address:
Legal Description:
Property Tax ID #: 1112-� �ns C//Z' �'�y C
Site Plan Name:
Project Name:
Setbacks Front Back: Right Side: Left Side:
Residential
Lot No.
Block No.
zli2e /Z-"( 1,1tf 1
Additional work to a pertormecl un er t is permit - CheCK an tat appy:
Shutters Windows/Doors
Mechanical — Gas Tank _ Gas Piping _ —
Sprinklers _Electric —Plumbing — Sp — Generator Roof —
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: — Sewer _ Septic Building Height:
Name /x..224- 1 11
Address: 1661 //0
City: C�- '� State: 0
Zip Code: ,dal %�` Fax:
Phone No. ��9D
E -Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
Name: ('urti5 S on S i
Company: A t'r SLA '� to i'nS IN C
Address: I(Q l S S E T,
~� State:
City: C�7 CS T ST LkC of-
Zip Code: 349SZ Fax: 97,�
Phone No. 7 7,)-
E -Mail: i` To, r
State or County License: CA C 0 5 18 !O S�cL
If value of construction is 258Tor more, a RECORDED Notice of Commencement is required.
`. UPPLEMENTAL CONSTRLI!CTIO
DESIGNER/ENGINEER: _ Not Applicable
Name:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
Address:
City: State:
Zip: Phone:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 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(;Wpg your Notice of Commencement. /17
S•Q1'1*`_1L____
�Q
J6
Signature of Owner/ Agent/ Lessee
Signature of Contractor License Holder
STATE OF FLORIDA _
STATE OF FLORIDA
COUNTY OF
COUNTY OF J
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this / day of 20 by
this /C;, day of _r,4A) 20 ; Eby
C�itrt, ,;�I'll mcnS
(>S�Nmm,nS
(Name of person acknowledging)
(Name of person acknowledging)
(Signature of Notary Public- St to of FI tda)
(Signature o of Notary Public- State of Flo a )
Personally Known ✓ OR Produced IdentificationPersonally
Known �� OR Produced Identification
Type of Identification Produced
Type of Identification Produced 8 ,.
-�Y
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Commission No. �� �syd�`% * e4IPYCOMMISSION #EE8592
EXPIRES: April 4; 2D17+>
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EXPIRES: April4, 2017
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
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MANGROVE
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DATE
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COMPLETED
Rev.7/2014