HomeMy WebLinkAboutBuilding Permit Application.?PLICABLE INFO MUST BE COMPLETED FOR APPLICATION'TO BE ACCEPTED
Date: /oZ /
Permit Number:
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
Address: ,At
Legal Description:
2�
Property Tax ID #: a7r -'r-1 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Mechanical
Electric
L1/tip 1 %/t .s .� /y.St�> ��F,nsc oor -
T
_ Gas Tank
_ Plumbing
Total Sq. Ft of Construction:
Cost of Construction: $ a,/ 0
Name
I,MF II I It - L[IVL
_ Gas Piping
Sprinklers
Shutters
_ Generator
Sq. Ft. of First Floor:
Windows/Doors
Roof
Utilities: —Sewer _ Septic Building Height:
Address: 26h .� ,0 -
City: 41,4 /_ J Stater
Zip Code: Fax:
Phone No. "l 1J- 1�' 3 1 -) l 3 9
E -Mail:
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: e)-rtl5_ scLvnmon _5
Company: (,us -rd rn Vr 5�l S fe m C )111 c,
Address:_ (kis S& `Ur Il�ap Gruen D, --
city: P09-7 ST UC 1C_ State: FL.
Zip Code: 34q&l Fax: `J' J35 ) 16,E
Phone No. 771 33S__30_31
E -Mail: i`usfi41r Su c ( co) cm
State or County License: CAC 05 1,F lO S40 -f2
If value of construction is 25Kor more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER:
Name:
Address:
City:
Zip: Phone:
FEE SIMPLE TITLE HOLDER:
Name: _
Address:
City: —
Zip:
Phone:
.x
Not Applicable
State:
Not Applicable
MORTGAGE COMPANY:
Name: _
Address:
City: —
Zip:
Phone:
BONDING COMPANY:
Name: _
Address:
City:
Zip:
Phone:
Not Applicable
State:
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
commencing work or recordiVg your Notice of Commencement. .,
Signature of Owner/ Agent/
Signature of Contractor License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF `1Y Wil/ .cz, COUNTY OF
The forgoing instrument was acknowledged before me
this / day of �uhJ 20±�? by
�ttr- rt
�)A ir1nlc:t�
(Name of person acknowledging )
Y4�y_�4- zs���
(Signature of Notary Public- St to of FI Ida )
Personally Known ✓ OR Produced Identification
Type of Identification Produced
CHRISTINE S. ENGLISF
Commission No. FE�Sy �� * e�41)MY COMMISSION 4EE8592
sEXPIRES: April 4, 2017
FOF Fief Bonded Tin; Budget Nolary Savc
The forgoing instrument was acknowledged before me
this _ day of 20_7 by
Cuf'bI SNmrn��
(Name of person acknowledging )
(Signature of Notary Public- State of Flo ' a )
Personally Known ' OR Produced Identification
Type of Identification Produced
°`• X`� CHRISTINE B. ENGLISH
Commission No.EE�}'j 1/,dc�y. * ai)My COMMISSION# EE 85928
EXPIRES: April 4, 2017
'•'FCF Rd�' BorW� Thru Sud?At Notary Sery;,e
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
DATE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
RECEIVED
DATE
! COMPLETED
ev. //2014