HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:�/ ��� �U/ ,/ Permit Number:
RECEI`'7D FEB 072017
WP 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:
PR®POSjED I!NPROU'E�M:ENT.L®CATION:
Address: I zzf�y/r�.yr r �'YLU y✓G i -�
Legal Description:
Property Tax ID#: �3d�— � Q o1— O03�-Odp- 6 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
D:ET'Agl!LED D,E�SC 41'Pl'10. 4F �®R�K•
nn -
n��;" e°�l � ��,.G/c S/�� o wev�-S Ccs •
CRYN8T00CTI°ON I'NFORM-A
Additional work to be performed under this permit—check all that appy:
_Mechanical _Gas Tank Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: C) U C) Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: _Sewer _Septic Building Height:
0�°WN�ER/LE�StiS�EEc,�` ' CONI'R ;CTO�R:
Name ...G ;��.w✓` ,:.. ?01Jv Name:. .:.;: , .
Address: 3 11-- - ✓Vvry y✓L (,!24 Company':
City: lam- / State:_ Address!:.', rC� ��Xv�
Zip Code: 3 lfySi Fax: City: �k�� -�... Stater/
Phone No. Zip Code: 3q9 f Fax:
E-Mail: Phone No 7 V _v•7�—
Fill in fee simple Title Holder on next page if different E-Mail /a'h1DL' ,V &,
from the Owner listed above) State or County Lice se &JY,,kr -9 R,
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SIJP'PLEMENTAL CONS(-RtJCI"I'®N LIEN LAVU INFOR:IIAl•L®;N_:
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 inspec ' n. If you intend to obtain financing, consult with lender or an attorney before
commencing wo o Coein vnijr Notice of Commencement.
4SA)
Signature w r essee/Contractor as Agent for Owner Signature of Co7ar7ce Holder
STATE OFF FFjjIDA STATE OF FL
.
COUNTY `mak . L.ac�� COUNTY OF
The:.' going instrume t was acknowledged before me The forgoing instrument was acknowled ed before me
this 1 day of 20_n by this day of ' 'F�k' , 20Q by
(Name of person ack wledging) (Name of person.acknowle ging)
(Signature of Notary Nblic-State of Florida) (Signature of Notary Pu lic-State of Florida)
Personally.Known OR Produced Identification Personally Known
Type of Identification Type of Identificati rL }' COMMISSION#GGoz2o2a {
Produced Produced - ;w
mbar 16,2020
�MpRIE GNENS ''e•• ' ed Thru Notary Publlc Underwriter..
Commission No. :.:. �SS10N#GGp22023 '' Commission No.
MY mbar 16,2020
pCPIRES:OPubIlcUnderv�rifer.h
Thru Notary
REVIEWS FRON KING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.