HomeMy WebLinkAboutBUILDING PERMIT APPLICATION All APPLICABLE INFOMUSTBE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: '5nPermit Number: ZZIQL-2: (D 0
RECEIVED
Building Permit Application
FEB / 1 2017
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:
PROPOSED INP111101111
Address: e) -f-, C'U FL I II a
Legal Description: Ad I U I T d _ l LO+
Property Tax ID#: a - (_00H - OOCDLO - coo - Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
IMES EW
OR+K:
�lurnh -C�or�1 cold >L,�e.l� �a -4o rn.�_
CONSTR?UCTION INFORMAffil UR N:
Additional work to be performed under this permit-check all tat appy:
_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: $ O(7
aSO Utilities: _Sewer _Septic Building Height:
OWER/LESSEE: C®NTRAC
Name Q + md Ganf-p- Name:
Address:-Jl_o Company:
city:TOW CL4 State:Et. Address:
Zip Code. C(clFax: City: State:
Phone No. IS-`pas q Zip Code: Fax:
E-Mail: - b f(,krl G 0 Phone No
Fill in fee simple Title Holder on next page(i different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SU'PP'LEMENTAL C®'NSTRUCTI®N LIIEN LA�11V IIVF®R11/IATION: EWE
DESIGNER/ENGINEER: __,-N-ot Applicable MORTGAGE COMPANY: ___-Net-Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ of 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.
Signature ofw er/Less ee/Co ntra cto as Age I r Signature of Contractor/License Holder
°qaa.rt F
STATE OF FLORID STATE OF FLORIDA
COUNTY OF a MK" COUNTY OF
The forgoing instrurngnt was acknowledged be rem { The forgoing instrument was acknowledged before me
this t day of =ate= 20_ffb v Z this day of 20_ by
/ � � l� v ✓— �� � c0 v
(Name of person a� nowledging) (Name of person acknowledging)
(Signature ofo ary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Keow. OR Produced Identification Personally Known OR Produced Identification
Type of Identificat' n Type of Identification
Produced —'a,- L,- Produced
Commission NC-/1 (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.