HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �Aa� \ Permit Number:.VN 0 VA G
RECEP,"D FEB 2 3 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:
PROPOSED INPROVEMEN
T LOCA ION:
Address: — r t;— Z) \ 01 % ve- 14r6C
Legal Description: Atj t � ) � J,1 U 2 ► >LlC I
Property Tax ID#: ( -( � /o _ -Z 'j Z"- D fir$ Lot No. C�
Site Plan Name: Block No. I. d
Project Name: slc v
Setbacks Front Back: A//7- Right Side: ��� Left Sider/--�'
D€T�AI�LED DE�S'CRSI-PTIO OF 0
1����c� i✓X i.� �«-� �-zv C�.� �»a ��l�--e� a�c,�1,«..� �,.�— w� �-1 ��f.:Q�.—fd KE
CONST 0CT O ' ORM.... :
Additionalwor to a pe orme under this permit-check a t at app y:
—,M�ec anical _Gas Tank =Gas Piping —Shutters _Win'dows/Doors.,
Electric Plumbing Sprinklers Generator Roof Pitch
— g — P — —
Total Sq. Ft of Construction: /�'��` Sq. Ft. of First Floor:
L�
Cost of Construction:$ �' 'L Utilities: —Sewer _Septic Building Height:
. . 'NER WIRSCONTRACTOR:
Name ) ? ' . '.�.� yc:::`:.' Name:
Address: Company: Cdq.S,:.k1
City: ' I' C�.. f`t- State: f-'L AddYess:.. 'Z I S`SS ".,5, _.;'��►(:1:':�-I- �d L���e
Zip Code:`b tl �S"Z Fax: City: Pal U, 6 r i` Stater
Phone No. 4' J (� 1% Zip Code'%< q f 0 Fax: 7 7 Z 'Z-" S7 fit'6
E-Mail: Phone No '7 7 Z- E7 /
Fill in fee simple Title Holder on next page (if different E-Mail iv C e's V'k &J ;C
from the Owner listed above) State or County License t�-c I
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
5 M • Sl'RU IO LIEN LAW INFrDRMOWN
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 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 obtainfinancing, consult with lender or an attorney before
commencing work or recording our Notice.of Commencement.
Signature of O`ner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIQA
COUNTY OF 5 - "c-\ COUNTY OF 'S�• L• y t:%-R,
The for oing instrume t was acknowledged before me The for ax
instru n was acknowlecled before me
this� day of ,20� by this a. day of .20NI by
W ull� A, t% c�
(Name of person acknowledge ) 7 (Name of person acknowledging)
A
(Signature of Notary PuRic-State of Florida) (Signature of Notary P blic-State of Florida)
Personally Known OR Produced Identification Personally Known ed Identification
Type of Identication Type of Identificatio Rf i'
YP EANNA MARIE GIVENS
Produced Produced s1oN
;.�µv ••,,• DEANNA MARRE GNENS EXPIRES: #GG 022023
MY COM I #GG 022423 fir,.;; Bonded IRE N December 16,2020
Commission No. M� Commission No. o(SABOrUndeMters
• EXPIRE . ber16,2020
o=.
•s;;ep;F o= Bonded Thru Notary Publio Undo SM _
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION , SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.