HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 177.
Date: 1 7• Permit Number:
4
RECEIVE®
FEB ®2 2017
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:
PR0 `®SED I�N{PR®UEMENT LOCATION:
Address: 90 0 Skf1?I [A ryI)- {�-3
Legal Description:
Property Tax ID#: l✓3D 33 I QOa 2 06 Lot No.
Site Plan Name: RDA0 AUhne-A- Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
D ED DESfCR PTION OF WORK: hF
1 e- 14 �).lt /���p� iv L dJ :c ,OL W
:2
CONSTR+UCI"ION INFC►RMATION:
Add
itiona work to a pe Orme under this permit-check a tat app T.
Mechanical _Gas Tank _Gas Piping Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers Generator —Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ ,� �� Utilities: _Sewer _Septic Building Height:
0 jNER/LE-�S�Sf E: CONTRACTOR:
Name (hseangn /Y1 Tn71X Name: T. 1011 L _
Addresss: 550D "A)n Company: ,l-&n_7':Z
City: cervi c) P)o2,-- State: l2 Address: On �560 FQS 5'A AD W��?
Zip Code: 3q*% Fax:772 z1,�y �% City: totb��lil/c-)� 'State: lee
Phone No. �72- 4)�k n%5 ;' Zip Code: _3ede-� Fax: 27,Z-q.��-005(-/-
E-Mail;� }ae./,? Phone No 2-81- 7b Z
Fill in fee simple Title Holder on next page(if different E-Mail f,cry)LiA
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CO'NSTRUCTI®N LIEN LAW INFORMATION:
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 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 recording our Notice of Commencement.
57
Signature of Owner/Lessee ontra for s Agent fo 0 . Signature of Contractor/Licens older ?,v%•.,,.•�;?
STATE OF FLORIDA 'fi°;%off :' STATE OF FLORIDA t a Xaa
COUNTY OF r COUNTY OF =
2 M=
m Rl< z fll�m
The forgoing instru t was acknowledged before is�o o The f°{going instru ent was acknowledged befo PRO W
this day of - 20 by Z rn�Q this�C day of 20— by F.
!� C=a'T=
Seo V-C/V?4-�E -n 0 tt
(Name of person acknowledging) (Name of person acknowledging)
N
(Signature o V
otary Public-State of Florida (Signature of Notar,/public-State of Florida)
Personally Kr own OR Produced Identification `fir Personally Known OR Produced Identification
Type of Identific tiq in Type of Identifi tion
Produced �'VY
nn
/ _ i '_Z C- Produced GC -�-t C_
�L(�A, '
Commission NJ (Seal) Commission NV (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014