HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 'Z® - f Permit Number:
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Building Permit Application MAR 2 0 2017
Planning and Development Services PERr,.4lTTING
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential X
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: I N r.✓I-Mw�-
Legal Description-.q 7i q 0 Fop, SE7 L.,•r d 'Ir' s �`� 045 z Y4 f j,,\ c��33. 1 _
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PropertyTaxlD#: z-gc)n Li�i"f ocio I GUO L Lot No.
Site Plan Name: . i 14 ( 44�d� VA Block No.
Project Name I +Amri-f►^c"
Setbacks Front Back: Right Side: Left Side:
[DETAILED DESCRIPTION OF WORK:
,ivave- 3 '�'rv -
CONSTRUCTION INFORMATION:
Additional work to be nertormed under this permit-check all appy:
EHVAC 0 Gas Tank E]Gas PipingShutters E;Windows/Doors
0 Electric F]Plumbing E]
Sprinklers Generator 0 Roof Roof pitch
Total Sq.Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ �� Utilities. Sewer OSeptic Building Height:
OWNER/LESSEE: 1 CONTRACTOR:
Name UUoril,. Name: (,)rl-r�,
Address:54 1 1ACA01611' 1U Company: N(L
City:57r+ �i�Qrc_er State:SF(- Address:_'�Z3i SC
Zip Code: do,y Fax: City: Statey�'
Phone No. (S92i - 53-3- '517-2- Zip Code: T-019 Fax:
E-Mail: Phone No,)7 L 2-.70
Fill in fee simple Title Holder on next page(if different E-Mail: c.J f buA 4 S a C
from the Owner listed above) State or County License:s LC.. jrC' 3
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: A Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: _Wot 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
commencing work or recording our Notice of Commencement.
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Sig re of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF STATE OF
COUNTYOFO MAQ. 11(� COUNTYOFORIA&A0[jn
The for foxing instrument was acknowledged before me The ing instrument was acknowledged before me
this day of 1AA10% 20 Eby this Z0 day of)AA$th% ,20 0by
CS-V44 5 J CLI-01
(Name of person acknowledging) (Na of person acknowledging)
(0
( ' ture of Notary Public-State of Florida) iinature of Notary Public-State of Florida)
Personally Known U�Produced identification Personally Known -OR Produced Identification
Type of Identification Produced /- Type of Identification Produced
Commission No. F�/ 31 0 35V (Seal) ComS�W� HO mission No. < (Seal) r SHAWNAM ODGE
or
NOTARY IC
STATE OF TAT
FLORIDApA E OF RIDA
Revised 07/15/2014 Comm#FF1318M Comm#FF13
Expires 6 Wit? lm M 0.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS