HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED r�
Date: %__2
rl Permit Number:_// ��-1����•`
RECEIVE®
lin 111iiiiiiiimiiii 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: 9/ it e&J-
PROPOS`ED IN,PRfJUEMENT LOCA�TI`�ON .
Address: 4404 gen6yoA 8z .
Legal Description: 14zJz4!R±J io'^- S /� _ . LWr �1a° /s�i�5�(0+2 39dS fly
Property Tax ID#: 13 ) a - '51 oa- &f�a g-' o®o" o Lot No.
Site Plan Name: Block No.
Project Name: 1
Setbacks Front Bac Right Side: Left Side:
DETAI-LEAD DE=SCRI,PTION OF V1/ORK'
/9 1764 le
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Jill 111JI&I 11 FlIgJ111i'l Ill
1__"_'._ON,STR,lJCT10_�N�INFORMATIO;N
Additional11
work to be performed 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: $ o Utilities: Sewer _Septic Building Height:
01N ER/ ES�SE'E �, �CO,��N�"TR��►�CTO:R:
Name C)TT S �SD_ eaA-o.3 . Y4wES �oea . Name: �CV'zTW (5L T12:ic LL L
Address: $4 e Y Xfow odA- b Company:
City: {tea 2; 'p, g_�zc State: rrb Address: W ' Agt
Zip Code: `3 y55 / Fax: City: V491)Zb 8, State:
Phone No. Zip Code: 3 JU�- Fax:
E-Mail: Phone No ala - S-Z 2 - 61 a 4�
Fill in fee simple Title Holder on next page (if different E-Mail Co v � �-<<ec-rizi c a!/ 4n^�
from the Owner listed above) State or County License_,_,'--c i 3 o o G sss
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEII/IBMW C®NSTR°IJCTION LIEN LAUV IN'F®"RIUTATIO: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 f • Record a Notice of Commencement may result in your paying twice for
improvements to your prop "rty. A Not a of Commencement must be recorded and pos don the jobsite
before the first inspection. f you inten to obtain financing, consult with lender or a attor y before
co work or recor in our N tice of Commenceme
Signat of Owner essee/Contracto s Agent 'e;'�py���p>i Sontractor/License Holder :?.....:�.
STATE OF FLORIDA STATE OF FLORIDA "'
COUNTY OF a COUNTY OF d
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The forgoing instrument was acknowledged bef The forgoing instrument was acknowledged befo0
this? da of J'?J Q 20 j7 b MSO W this da of h�i�t_r/ 201 b o m�R
v ��►6-I� . v o= v b y d �c
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V �� '-We1S onC. o ISL 124 n a) E °:4
(Name of person acknowledging) ^' (Name of person acknowledging) _. _<
N
(Signature of Not y Public-State o Florida) (Signature of N a Public-State of Florida)
Personally Kno OR Produced Identification Personally Known OR Produced Identification
Type of Identi atio Type of Iden tion
Produced Produced
Commission No. (Seal) Commission N (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.