HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: , ��] Permit Number: 12 0-�=a A4o
RECEIVED
WW Building Permit Application MAR 10 1017
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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PROP05ED INP'R;OUEMENIT LOCATION:
Address: -5rd P r . ���� �,o_d'ce ��'
Legal Description:
Property Tax ID#: 1 a 0r 9 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
KETAJLE11191 NS* IPTIO -,c
—[^Gnsf¢ 1� AI_96010 7Gc� dnc� C o17G7 CC ..eXlS/ /h q ca;l'c ;
new wV(ite r-. 'b eq fed`f,, oiA; A em a- =
CONSTRUCTION I I F®R'M TION:
Additional work to-be performed un er t is permit-check all that appy:
Mechanical Gas Tank GasPiping Shutters`- Windows/Doors
1ectric Plumbing —Sprinklers _Generator, Roof Pitch
—. t
Total Sq."Ft of Consfruction:.- Sq. Ft:of_First Floor::
O®. oo Utilities: Sewer Se
Cost of Construction:$ .3 — tic Building— p ' g Height:
OWNER%E;6S E: CONTRAC OR:
Name d- t' Name:-.Ad pti'gv' o'f/�� Corn7�inc�orS..L//c
Address: 3 s. z7o;0 �� Company: Joocre) c , L,ed4z9en
City: :�Efi p;04ce State:— Address:
Zip Code:,��9/f G Fax: City: r-f- �' r•c_c� State:FZ_
Phone No. Zip Code: >1&' 41? Fax:
E-Mail: Phone No 390-5�r760'
Fill in fee simple Title Holder on next page(if different E-Mail cr 11Wgs ; c K'7AO". cram
from the Owner listed above) State or County License—& OOaA-7a 2—
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
OPPLM&MAIL CONSTRUCTION LIEN LAW [NF®R`IUTATI®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 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 Commencem
Sig at, r of Own /Lessee/Contractor as Agent f Sign tur -of Co tractor i older
STATE OF FLORIDA r STATE OF FLORIDA "
COUNTY OF `'°"i COUNTY OF
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The forgoing instrument was acknowledged before X�a The fQQr��oing instrument was acknowledged before mM m
this da of -}(— , 20 b °� this da of SPa f`5`f-zfl b a �'�
Yt'_T — y z ms< y C� y v ° z c
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(Name of person acknowledging V (Name of person acknowledging) �N
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(S nature of Notar Public-Stat of Florida ) (Signature of Not r Public-State of Florida)
Personally Known OR Produced Identification Personally Known AOR 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
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