HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 31a\��� Permit Number:
,• RECEIVED MAR 212017
cz,2-1321115" 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:
PROPOSEDINPRQVEl1/IEhITL'OCATIONa
r::.
Address: cJ Q 0 I 4V&PJ U G pe c f, FL 3 6( `L1
Legal Description:
Property Tax ID#: (Dk �0 t-G 11 C7 o 0 Lot No. 3
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
;CONSTRUCTION INFRORM'ATION WWR
Additional work to be per Orme . under this permit-check all that appy:
_Mechanical _Gas Tank Gas Piping _Shutters Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction:- Sq. Ft.of First Floor:
Cost of Construction: $ /2 0 Utilities: —Sewer —Septic Building Height:
�
501N,NER/LESSEES „ 3�* ��':�CONTRACTOR
.-�,.. a.,s�:,ar... F�:,: n_s#'v ..r .c is..,J'c'' _ .,s?1',. .`i,,..a _.... �5:, ... .k�w�"tt :::. d,fl..
Name �.. �t��J�r� Name;.
Address: L( t7(�'l Company: ,(n,lt �ec-rr:c%re=SF
City: C-6,-, 4, c c,Kms- State: E G Address: l:o y G :5' lJ -FP9-kyy 16. /4vFj
Zip Code: (�N Fax: City: Pot'T``S k 'L VLi-e_ State:—(-
Phone No. J`-) ?'Z' 11��12-11110 Zip Code: 3 c4 -16'3 Fax:
E-Mail: Phone No -t4 5 2 C-31 l 7
Fill in fee simple Title Holder on next page ( if different E-Mail �', w. �T 4 S_e r 1111 i i (� f,m w i L.Go-
from the Owner listed above) State or County License F p 3 ao )LI S ?
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SU111 11111- �
`PPLE'IUl'ENTAL CONSI"RUCTI®N LIEN LAW INFOR ATI®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 r@corcling your Notice of Commencement.
Signature of Own&f/Lessee/Contractor as Agent for Owner Signature of Contrac or/License Holder
STATE OF FLORIDA STATE OF FLORID
COUNTY OF SAI. %--J'r— �-t COUNTY OF '6 • "C%P,
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this% day of TCN0,.4 20 h by this a l day of 20_Vl by
4N, WN r :� 'S "YS 4,d W d►r� 'a w,\'C N1
(Name of person acknowledging) (Name of person acknowledging)
�"I'l""Illillll� ; l��: ll,, ''..C,�N;�n� . �-�> I I 1 1,nt��
(Signature of Notary'Public-State of Florida) (Signature of Notary Pu lic-State of Florida)
Personally Known OR Produced Identification Personally Know OR Produced Identification
Typeof Identification Type of Identific io�q[,� ;g:.,,.,,
�. Produced f D�IAh1ARIEGil
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Produced ION# r'
PIRES. eG
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Commission NO. DFANtI/µ ` GlvErssuzs i Commi$sion NO RAe -Nota cep e de��o }`
...... $SIOfrJ1 GG 02 7r �+ is...nderurr.oma
cr°•• MY COMMI �g 2P]20 1
_r: �' EXPIRES:Decetnber Cervrriters '3
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REVIEWS F SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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