HomeMy WebLinkAboutBuilding Permit Application All APPLICABL .I FOM ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: Permit Number: �� 1
RECEIV7D FEB 10 2017
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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®PC}SED INPR'OUE"M'ENT' LOCATI®N:
Address: -7 L.4pcz SS 5T- _P5 l_
Legal Description: (., LY ( —o1.y- fLD T (3
Property Tax ID#: LA V9 !Lb 1 00914 OCZ2 5 Lot No,
Site Plan Name: o� Block No.
Project Name:
Setbacks front Back: Right Side: Left Side:
DETAILED DE�SCRIPTI®N O WORK:
Q(J f_�- TZ)P C:\cS NG- l
2/ 17Qt
�C*@STR+UCTI®NI INFOR+MATION:
Additional work to be pe orme un er this permit—check all that 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� ��'� Utilities: —Sewer —Septic Building Height: /0 F`r
OWON IN CTOR:
Name (-fIGScPP6 ?A-oNL—S5A Name: _ `y,
Address: _75 Q4YL&-�Sc` Company: 6A:E
City: -PS(__ State:r Address:3>,71 A&/&
Zip Code: 3gqFax: City: Y:�TPIeV,,� Stater
Phone No. �1/' 5:31 2 f b3 Zip Code:, Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License CC645_S_5'_2 10
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL C®NSTftl1CTIINU FI'U LAW lNF'OR=IVIATI®l�:
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 roperty. A Notice of Commencement must be recorded and posted on the jobsite
before the first ins ctii,n. you intend to obtain financing, consult with lende attorney before
commencing w or r or 1n our Notice of Commencement.
Signature of Owner essee/Contractor as Agent for Owner Signature of Contractor/License er
STATE OF FLORIDAt� STATE OF FLORIDA
COUNTY OF --= G—ti COUNTY OF 1�
The fcugoing instrta�en� was acknowledg before me The in instr nt as acknowled a before me
this `""] day of }�___��� 2oby this��day of���_,Zp��y
(2 r)
( ame o person acknowledging) (N m of person acknowledging
E
{Signature of Notary Public-State of Florida) l {Signature of No y Public-State of Flori4) _
Personally Known `.� OR Produced Identification ersonally Known OR,Produced Identification
Type of(d6ritrfatt
i ' Type of Identification/
ro uced .;tt Kra ANGELA M HUFF ro aced
imary Public-State of Florida ANGELA M HUFF
Commission#FF 23 mal) Commission y ���
Commission:Nat:'rte= . q =r°, .%; Notary Public-St +orfda
es May 27,201£ -•ti .•= ommission# 234 30
I
through National Notary Assn, ` =� o�c My Comm.Expires May 27,201 o t.
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