HomeMy WebLinkAboutBuilding Permit Application 7
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED U
Date: °� a3 Permit Number: 11®� i Ciao
�- RECEI '70 FEB 23 7017
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
P.R'OPOSfD IM PROVEM NTLOCATIO;Nr �
Address:
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Legal D scri111)Pption: �.r LL /1/9�,L, r 3
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Property Tax ID#: - . OC)d Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF,WORK
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CO;NSTRUCTION,IN'FORMIaTION
Additional work to e e orme under this permit—check a appy:
HVAC G Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric LYS Plumbing ❑Sprinklers F]Generator F] Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ r�V Utilities-Ti Septic Building Height:
OWNER/LESSEE ,�: � ��t f '' CONTRACTOR '� `
Name Name: ,
Addre s: . f0 r�.e 2CZQ� Company: r
City: State: Address:
Zip Code: Fax City: Stater
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Phone No. Zip Code: Fax;��� y�`�
E=Mail: Phone No.1 1 •511 t>
Fill in fee simple Title Holder on next page(if different E-Mail: Yri 1)D
from the Owner listed above) State or County Licen
V 011q!7 AW
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION,"LIEN LAW INFORMATION•3 ^''f {
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
comry)qncing work or recording our Notice of Commencement.
s
Si ner ee/ o r o e or Owner lgna re ontractor/Licen of er
STATE OF FLORID ,,` '� STATE OF FLORI
COUNTY OF `�� I R-0- I e COUNTY OF
The f ing insVwnqnt was acknowledged b fore me The fo going of
b e t was acknowledged fore me ,
this day of 20 J Jby thisZ, of 20 Z by
4 P2 t d(-, d
(Name f erson acknowledging) (Name of p on acknowledging)
gnature of Notary P I -State of Florida) ature of Notary Publ' - tate o Florida)
Personal) OR Produced Identification Personally Known Produced Identification
Type of Identification Prpdu._.. Type of Identification Prod _
K r rY,eG� BE
v,r 'Y"y''• LIBERTYA KING
<; " r .': MY��ION#EE 877248
Commission No. :.: *: MY C�1df� lON#EE 877248 Commission No. :a= E May 4,2017
=;, d EXPIRES:May 4,2017 `T aF ?P` Bonded Thru Notary Public Underwriters
Bonded Thru Notary Public Underwriters
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS