HomeMy WebLinkAboutBuilding Permit Application All APPLICA E NFOQ7LIST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �(J f C Permit Number:_ - Iib- 105,13
RECEP.7D FEB 282017
r.
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: ^r
A.M
PROPQSE I"NkPRQ/UEME�IT�LO ON: r r�
Address: 62311" 6 EMN �Ol ��� n S�e� Pt .. PL 3L�c1 S
Legal Description:
Property Tax ID#: 130 b0 G '02A0 000- 0 Lot No.
Site Plan Name: Block No. (�
Project Name:
Setbacks Front Back; Right Side: Left Side:
® TAI°hED DESCRIPT01N0
j ry'
rGSS;fR�,l1 RTi1.0 INFO MATfONr�
Additionalwor to be pertormed under this permit-check all tat appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction
$ "t �7�� Utilities: _Sewer. � '18bilding Hei t: '
W ER
Name 'Vo Name 1'C11�,cSAW
1y1 .n eC'Sc,1x) . ., .qv'?_' 'ar � t��.
Address: & S11 lre6-4'�. � t ``�' ', :' Company:- z ..,. y ?i-la "' y�
City: pY`CQ State: - Address-,., b(.(SG
Zip Code: r3tC^S( Fax: City: VRM Ct State:
Phone No. -70 5LQ7 Zip Code: 649q 0 Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page (if different E-Mail Qrp
from the Owner listed above) State or County License C G G 6-7_R_57
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SU'PPLEIVIENTAL CONSTR CTI®N LIEN LAW IN:F®RMA 1®N:
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:rest:rictions 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.
Signatu( Owner/Lessee/Contractor as Agent for Owner Signatu a of Contractor/License Holder
STATE OF FLORIDA e- STATE OF FLORIDA
COUNTY OF Lucie COUNTY OF
The for�oing instrupagrlt was acknowledged before me The forgoing instrument was acknowledged before me
this Z day of Ir'Ncw-tl ,20 1')by this2�day of PP_ n 20 111 by
�Y11 t' NeU_�
(Name of person acknowledging) (Name of person acknowledging)
(Signatu g>)67ITH (Signature otary Pub'c-State of Florida)
Persona 6) i own- SC tI�Wduce 'I entification
Type of 1 e6li MISS10m#F�� rip `66 T ntif�l� ~� so
#FF984666
Produce u EXPIRES May. 0 A"r i 1 P T P
. .� ta► _ ,*u i u� c
PAW I,`. BTArE of �11*0to THROWM j
Commiss on ea I Co aeon No.wI �P� (Seal)
J
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.7/2014