HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: fi�[ 3� 17 Permit Number:
-- � R E CE 1'ti 7 D MAR 13 ZD17
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce TL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial --:,,/—/—'
Residential
PERMfTAPPLICATION FOR:
-
Address: S 76 (j•�.g,� Ai e FY A-trr e- `lfi 417
Legal Description:
Property Tax ID#: 2-111, `0 l- 600 1 '6 0-0 ' 3 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
C4 G.l/oma rd !�n ` Lj P -
6
^fl,'f-E.-+
Additional Work to be pe orme under this permit-check all that apply: -
_Mechanical _Gas TAnk "`6as Piping• —Shutters _Windows/Doors`
_Electric -/Plumbing —Sprinklers —Generator —Roof
Total Sq. Ft of Construction: pp" Sq. Ft. of First Floor:
V
Cost of Construction: $ 7 rJ , o o Utilities: Sewer —Septic Building Height:
_ -•--y_-^fes-
^.'.�Xsie.'�-"'.'�
NE
Name �,Ri-'s Name: � C�iS : k-,Oc,_,
Address:. ..01_ ALS Company:
City: , �'�eG State:F Address: j.701...s.'.:?�_Zh
Zip Code: 3L ..moi.7 Fax: City: R A-cr-c,e... State:��
Phone No.07 1, J-70 - / I /S Zip Code: 3" Fax:
E-Mail: Phone Nc�2721 561-30-13
Fill in fee simple Title Holder.on next page ( if different E-Mail
from the Owner1isted above) State or County License 2,?r,d
If value ofconstruction is Z500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not r.pplicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE FOLDER: Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
0WNER/ CONTRACTOR AFF€DV17: 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 use to another non-residential use
WARNING TO OWNER: )'our failure to Record a Notice of Commencement may result in your Raying 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 w rk or recording our Ng_tiof Commencement.
Signature of Owner/Agent/Lessee ontractor Signat e o Contractor/License Holder
STATE OF FLORIDA STATE OF FLOgIDA ,
COUNTY OF 1.V C �C COUNTY OF
The forgoing instrument was acknowledged.before me The forgoing instrument was acknowledged before me
this x day of o►C 20 11 by this_day of VT'-,q'C 24:1 by
C-�
(Name of person acknowledging) (Name of person a knowledging)
(Signature of Notary Pu i -State of Florida) (Signature of Notary Publi -State of Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification .
Type of Identification Type of Identificatio
Produced nF-ANNAMARIEGNENS Produced
MY COMMISSION#GG 022023AdARIE Gf�NS
ber I 2020 Pp..,... MY ON#GG 022029
Commission No. o= �O�publicUnderwrlters Commission No. �4 � y 6
••;�E••.•o,. Sonde Thre oteN I �emberl 222..0
Bonded 7bm Notary Public UndPm6to, €
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
,ev. 14