HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: aT,�, Permit Number: �1 c7a'd3�5
Es, _. , 11.=: .,, R E C E I% D FEB 212017
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: To Select from dropbox, click arrow at the end of line J a
PROPOSED IMPROVEMENT LOCATION:
Address: 13& 1JG1-X'-S 34.11,1
Legal Description:
Property Tax ID#: !-ISO a -,)"o 1 o6a), oco W Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Q F MU fa�_ Ell'41e ?A t-/44 JVC L AW 1,Ef r
N ° b s ���- (''-
CONSTRUCTION INFORMATION:
_itio workto e Performed under tispermit—checka appy:
VAC Ll
Gas Tank []Gas Piping M
Shutters Windows/Doors
Electric Plumbing USprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ ��5iP70 Utilities:cnSewer 0Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name 1\IG P. t k Name: L.(
Address: 98_ OC,EAAJ 1/i&J Company:_C7(,z402:rii,�'1 A& We-
City:
AICCity: .5V-11EI`4M.P_,1'0!) State:/V Address: X33 /y 44)
Zip Code: )I DI G b Fax: City: State:
Phone No. O i 0 t o U Zip Code: -.3-4 ,9 03 Fax:
E-Mail: Phone No. flnc, ago �fV;-J
Fill in fee simple Title Holder on next page(if different E-Mail: Z L&kAXI' (aMc".r S,,-
from
rfrom the Owner listed above) State or County License: q_A CO 4.-10 !ZX
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW 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:
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.
s
Signature Owner/Lessee/Contractor-as Agent for Owner Signature of ontractor/License Holder
STATE OF FLORIDA STATE OF FLO IPA
COUNTY OF 5 a-. L u c % rt COUNTY OF , Luc
The forgoing instrumacknowledged before me The forgoing instrument was acknowledged before me
thiA\ day of en was 20�1 by this:)�\day of T-43i— ,20 %-1 by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Publl State of Florida) (Signature of Notary P lic-State of Florida)
Personally Known OR Pro uced Identification Personally Kn ••• fication
Type of Identific ' Type of Ident t, k'Zoducei&AN
•,.•;"+;"'••,
DEANNA MARIE GIVENS a MY COMMISSION#GG
MISS 022023 Commission S:December($�p� 3
Commission No. _ �i Commission d:•.
PI ES:De mbet 16,2020 Notary Public Undervmters
.r';,Zd�`•• Bonded Thru Notary Public Underwriters
I •
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS