HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
-7 Permit Number:
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. K Building Permit Application
FEB 2 4 2017
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:
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Property Tax ID#: y 3(1, — (, 01'O U 13—boo— b Lot No.
Site Plan Name: 14 a” ")t C Block No.
Project Name: .5��1,✓ti
Setbacks Front Back: Right Side: Left Side:
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Additionalwork to be pertormed under this permit—check all that-apply-
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at appy:
Jecfianical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Viectric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.
of First Floor:
Cost of Construction: $ go0o• 0d Utilities: /Sewer _Septic Building Height:
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Name A AP Sc,4 Name: K.e o
Addresss::2511 Ow L-#O1( Company:
City: 0—(,4State: E Address: 2Z Nw 63CV1Ph-4 S
Zip Code: 3 Y� 0 Fax: City: P re State:
Phone No. ZYS— SNI— 33000 Zip Code: �Y� 1003 Fax:
E-Mail:
Phone No ?72- 3.99-- ? 3Cr3
Fill in fee simple Title Holder on next page (if different E-Mail rem S OSA�5��0, �u • A
from the Owner listed above) State or County License
If value of construction is 2500 or'more,a RECORDED Notice of Commencement is required.
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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 cov.enants,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, pdrform'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,rodms and accessory uses t(oanother non-residential use
WARNING TO OWNER: Your failure to Record a Notice of Commencement may result in your paying twice for
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improvements to youproperty. 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 your Notice of Commencement.
..........
Signature of Owner/Lessee/Contractor as Agent fo Signature of Contractor/License Holder
STATE OF FLORID4tk-I M< STATE OF FLORIDA
X
COUNTY OF O= COUNTY OF
The forgoing instrument was acknowledged before i' �O 5' The forgoing i t t as acknowledged befo
13 .2= . ng inst�gn w
=- = M ib n)�P' by
this,:l'?3(clay of 20�12 by thio day of 2 Inno!
sn'
-Tie 0 e- e- J�
(Name of person acknowledging) (Name of person acknowledging
0j n
ej J]" k 1J131 4f-
(Signature of Not Public-State of Florida ) (SigAture of Notary blic-`State 8'rFilcricla
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
�_e_v. 71ZO14