HomeMy WebLinkAboutBuilding Permit Application?PLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 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
PERMIT APPLICATION FOR:
Address:
Legal Description:
Property Tax ID #:
Site Plan Name:
Project Name:
Setbacks Front
d'IAO
Back: Right Side
L //z --- P2 L/x� 3-1'- ^ / Y's --er
Residential
Left Side:
0AYESC 0tvr,
Lot No.
Block No.
Aaaitionai worK to De perrormea unaer tnis permit– cnecK all tnat apply:
_Mechanical _ Gas Tank
_ Gas Piping
_ Shutters _ Windows/Doors
_ Electric _ Plumbing
_ Sprinklers
_ Generator , Roof
Total Sq. Ft of Construction:
Sq. Ft. of First Floor:
Cost of Construction: $ }� `i C' ''
Utilities: —Sewer _ Septic Building Height:
Name P,u P k"I�dA 4011. a �yfnN�i't
F,;" -f
Name: So-mmon S
Address: i c'J� H .cJ ', f�4
/C+urtcs
Company: l USTdm A i*r 51 S to ins 7 G
�
City: Neu:'
State: QAddress:
t� l S S E Ti I (Ccao ren D, -
Zip Code: 1381.3, Fax:
City: 'Voe7 ST i-1kCic- d State: F -L.
Phone No. ? IS - %02 - 4 5.5"i
Zip Code: 34 9 Fax: ' U 33S 1 ct 6 F
E -Mail:
Phone No. 771 33.5 -3),32
Fill in fee simple Title Holder on next page ( if different
E -Mail: LU SfiaJr s� t V C-0 ) (,C -m
from the Owner listed above)
State or County License: CA C 05 I,F /O S�a�e
if value of construction is 25e0for more, a RECORDED Notice of Commencement is required.
7,-0O
,sU
DESIGNI
Name:
Address:
City:
Zip:
(NEER:
Phone:
FEE SIMPLE TITLE HOLDER
Name:
Address:
City:
Zip: Phone:
Not Applicable MORTGAGE COMPANY:
Name:
Address:
State: City:
Zip: Phone:
Not Applicable 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 recori;kn, g your Notice of Commencement.
Signature of Owner/ Agent/Lessee Signature JContractor License Holder
STATE OF FLORIDA
COUNTY OF 31f
The forgoing instrument was acknowledged before me
this �)& day of ,✓ N ti' , 20 ,"'7 by
C1 Lt r "t r s �A rT1 rn c n S
(Name of person acknowledging )
(Signature of Notary Public- State of FI Ida )
Personally Known OR Produced Identification
Type of Identification Produced
STATE OF FLORIDA
COUNTY OF jz aC p� 6t'e_�
The forgoing instrument was acknowledged before me
this ti E day of i 20 1, "' by
L'�Cr�is HrnrncnS
(Name of person acknowledging )
(Signature of Notary Public- State of Flovvoa )
Personally Known OR Produced identification _
Type of Identification Produced
CHRISTINE B. EftGLISHCHRISTINE B. ENGLISH
•.
Commission No. �E �sy��� * e}I)dYCOMMISSIONdEE8592a Commission No. EEct�S 1/,ddzy +�)�1YCOMMISSION #EE8592E
EXPIRES: April 4, 2017 EXPIRES: April 42 2017
t 'OF FICP ` Bonded Thr; Budget Notary SWCys Bonded Thar Bit Notary 5,,we,�
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COUNTER REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014
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