HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: aA �1 R Permit Number:
RECEIVE FEB 15 2017
'.s rO s v
.K
P
T rnF � � pu µ 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 V
PERMIT APPLICATION FOR: ��\� X�)_:
PROPOSE-�D INPRO�I/EMEN�T LOCA�TIO�N�;; ;� r a__-
Address: I
Legal Description:
Property Tax ID#: �3 `"` �-' 4 Cie\y Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side: J
,SDE#SAILED DESCR PTION OF 1IUORK*
!Spr
-
/4a$ rll2 C T /
C0N5}1t'RUCTLON INFORMATION
` yy.. k 4
am ic.'h Vii.ANk.rv.
Additional work to be performed under this permit'-check a t:atapp y
+Mechanical —Gas'Tank —Gas Piping Shutters _Windows/Doors
_Electric _Plumbing —Sprinklers Generator _Roof
Total Sq. Ft of Construction:� Sq:-Ft>,of.Frst Floor:
/� — Utilities: Sewer Septic Building Height:
Cost of Construction: $ � U — —
OW;NER%LSSEE' 3.,.. . �. �_ _..:E °DNTRACTOR �
Name ^t`1 �l - Name:
Address: I CI U OL ��VTt1 `� Company: �k
City: F4- ,`f_1'r State: Address: s//���
Zip Code: 04850- Fax: City: X Lh e-CM2 State:_
Phone No. Zip Code: �3- CI 8 Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page ( if different E-Mail126'1��� f�&nCr~ g C-rma �, cocry
from the Owner listed above) State.or County License /9 3tZn1
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SPP�LENIENTALCO'NS R'U�C�Tf,ON LIEN�LAIN 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 thepermit 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 w rk or recording.your Notice of Commencement.
Signature f Owner/Le /Contractor as Agent forRm
Signat a of Contra o /License Holder
STATE OF FLORIDA , STATE OF FLORIDA ?= �
COUNTY OF COUNTY OF
The forgoing instru e as acknowledged before The for oing instrument was acknowledged before E���
this day of D I 20i by J�o o this.day of 20�&by
2 MMM
CDM
TQ
h n CD
(Name of person ackowl dging) (Name of persbn_acknowl dging)
N
� N t
abJ4 M A:22n_,"A
(Signature y NotarPublic-State of Florida) (Signature of Not ry Public-State of Florida
Personally Known OR Produced Identification Personally Known �OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION. SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW . . REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014