HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Numberb d-Q,d
zk: _ RECEP.77D FEB 21 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:
PROP.�OSE�D INPR® ENT LOCATION:
/rQ
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Address: 7Y-0q
Legal Description:
Property Tax ID#: Lot No.
Site Plan Name: i9o Ic &,a-- Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DE AIILED DEaSC �I'PT'I®N OF VUOR' ;
T h.i5 yqsi e_ voaln i,-, I0-e- uw-n cA-r�rj. ure �a r
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CONSTRtUCTION IN�F®:R�IVIATlO"N:;
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 Pitch
Total Sq. Ft of Construction: ,,l Sq. Ft. of First Floor:
Cost of Construction:$ 2-660 Utilities: —Sewer _Septic Building Height:
ORr"�N:ER/L� ES�E��; CONTRAC ORS
Name
Address:_ 6zr l4a,L- dl�6 Company-
City:
ompanyCity: ee-S, L LQ State: L Address:
Zip Code: �qqej Fax: City: State:
Phone No. On) 51?-62S`]- Zip Code: Fax:
E-Mail: 6)v44Lb,CGv"1 Phone No
Fill in fee simple Title Holder on next page (if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CON'STRU'CTI'®N LUE;N LAW hN+FORNMATL®
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_p full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory uses to�ariother 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
commencinR work orrecordingr Notice of Commencement.
Signa re cT Owner/Lessee/ tractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORID STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrum nt was acknowledged before me The forgoing instrument was acknowledged before me
this 96\ day of F ,20V7 by this day of ,20_ by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary PublibJState of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification a of Identification
Produced MCAIMK MARIEGNENS P duced
MY COMMISSION#GG 02202
Commission No. �1 (S�IRE&December16,2020 C mission No. (Seal)
.•'•; o���o;•' Bonded Thni Notary Public Undenxri ers
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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