HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 21-711 -7 Permit Number:
I` u� RECE1V7D FEB 0 7 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: \-� V <:N,
PROPOS'�D IN`PROUEME NT LOCATION:
Address: /1?6 r- r
Legal Description:
Property Tax ID#: �� �� 5�5 J�d�' d�d" Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DE AILS
@WMIM®f mam.
CO �STR=U'CTIQ I N FORMATIO'N
A
dditionworkto a pe Orme un er t is permit-c ec a tat appy:
Gas Tank Gas'Piping _Shutters fldindows/Dddrs
Electric _Plumbing _Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: c ... Sq. Ft.of First Floor:
Cost of Construction:$ ��U v�- Utilities: —Sewer _Septic Building Height:
0 NOR LE�SSE : CO TRA O'R.
Name
Address: l U .. 1/ . . Cdrripanye of
City: �/`� .�-�• CG�e State:/=' Address:', ,V d '' 4:
Zip Code: �� ,7 Fax: City:` - State:F'
Phone No.& 7.? Zip Codeqi'ilr"
�o Fax:
E-Mail: Phone N 71
Fill in fee simple Title Holder on next page(if different E-Mail o2`r..7GP s�
from the Owner listed above) State or County.License 0(07��•�
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
5 PL� � •ONSTRUCTION lEN LAW I�N�FO MATIO .
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
commencingwork or recordingour Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgo' �strument was acknowledged before me The forgoing instru ent was acknowled ed before me
this�day of �� ,20� by this day of ��- 20� by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary P blic-State of Florida) (Signature of Notary P blic-State of Florida)
Personally Known OR Produced Identification Personally Known wsio
Type of Identification Type of Identific 'o ;� •'' '? OEANNAMARIEGNENs
Produced L
�. MY COMMISSION#GG 022023
�—� _ Produced
e.....: ecemkr 16.2020
'' oR;W Bonded Thru No
5� NAMARIE%31vENS " Underwriter;
Commission No.]CE—EA rtip:► ,; (Sea 3C mission No.
MYTOMMISSION#GG O220
=*� •'"= IRES:December 16,202
EXP
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REVIEWS FRONT SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW- REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014