HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: . )� Permit Number: 1103
-04-
.. RECEIVED
Building Permit Application MAR 2 3 2017
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: To Select from dropbox, click arrow at the end of line
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PROP®_SE® Il1/IPROU,LEMEN1' L®CAON; 1,0
Address: I I S i\J ( taIlS i9-,3t5PQ
Legal Description: S PAnJ 1,S1 LA-V-� Cu,.lif2y cf
Property Tax ID#: t ` l I l 1 /100 1 Dobe Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DfISCR111; 01®1
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C®;N TRl1`CTION IN!FO,R IIATLQ'N:
Additional work to r orme under this permit=c ec a appy:
GasTank Gas Piping Shutters
HVACrsQ Wiridows/Doors _
Electric 0 PlumbingSprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction. (5-66 Sq. Ft.of First Floor:
Cost of Construction.$ 's boo, Utilities:Sewer 0Septic Building Height: 1 SroLui 40
OWNERjLE�SSEE: C®NTRACIT®R:
Name A P.oL�b NoV_il w C=l C-,LL--- Name: S i Ly6to
Address: 11ri L L5 oxtispo Company:
City: a State: (5�L Address: 32-11
Zip Code: 3t-r q,r 1 Fax: City: 'i-C State:��
Phone No. 1 1 to Lq 0-7 3 11KC1 Zip Code: T LJCW 7i Fax:�-_Z -uLl--QE�
E-Mail: Phone No. )�?Z �Qy-7
Fill in fee simple Title Holder on next page(if different E-Mail: rA-,Tbw" P_aaF=w� V
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
�SUPPLEME`NTAL CONS�TR�UCTION�LIEN�LAUV�INF®RIVIA�TiON � _�� � a � a� F �K'
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DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY:y _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:
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 posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with le r an attorney before
commenci or or recordingour Notice of Commencement.
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Sig a u e o ner Lessee ontractor Agent le Signature of Contractor/License Holder w�N
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STATE OF FLORIDA =off z STATE OF FLORIDA
,*.COUNTY OF m N� COUNTY OF
W_�W
The forgoing instrument was acknowledged befow° The forgoing instrument was acknowledged bef
this day of,)y��1IR 12_ 201 m thi day of I�-- 20
_rie y� (/4JTO TV Cr� a .o- C Y rl NOT0 N Gil
(Name of person acknowledging) (Name of person acknowledging)
(Signature of N Public-State of Flori a) (Signature of Not Public-State of Florida)
Personally Known / OR Produced Identification Personally Known _,----,OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS