HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit.Permit.Number: g
Building Permit Applicati®n MAR 2 7 2017
Planning and Development Services PERMITTHNIG
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
PERMIT APPLICATION FOR: � �
PROPOSED IMPROVEMENT
II LOCATION:
Address: W - IBJ L.0. 2 I- Ct pC' �a
Legal Description:
Property Tax ID#: D3 -s 0a —tic) Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right-Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work o e pe orme un er this permit-check all that appy:
_HVAC _Gas Tank _Gas Piping _Shutters —Windows/Doors
Electric lumbing _Sprinklers _Generator _Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ � Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name EaSy LYi.)iLi -. ...__V - Name,:. '``--'+° I
Address:: ,. S '14w f Company: gfa
State:
EC—C � Addres
City: s: !S�
p
Zip Code:
.3 �(J o� Fax:; City, ]'O r e je State:—
Phone No. 7 7c t d 7 Zip Code: Fax:
E-Mail: Phone No.
Fill in feesimple Title Holder on next page(.if different E-Mail:
from the Owner listed above) State or County License:
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: _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 thepermit 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
corpnQncing work or reFqNing your Notice of Commencement.
S
ignature of Ow er/Lessee/Contractor as Agent for Owner Sign ure of Contr tor/Li ense Holder.
STATE OF LORIDA STATE OF FL RIDA
COUNTY OF ��. (r 6/
e COUNTY OF
The forgoing instrument wa acknowledged before me The forgoing instrument was acknowledged before me .
this 1-2 day of ^4 20 /�by this j,�M day of lW c+Te,4i 20 0 by
(Name of p son acknowledging) (Name of per on acknowledging)
(Signature of Notary Public-State of Florida ) (Signature of Notary Public-State of Florida )
Personally Known ✓ .98'M r duceVftAVML�AG� Personally Known '// OR Produced Identification
Type of Identification P Mc Type of Identification Produced .
:.:
�,,+r�••...•••a,: E I June 16,2017
Commission No. .F�F�° �(gc�a�1 Commission No. °�'""°i'a` (leg GAGE
7)398.0153 Florida otaryService.com s
MY COMMISSION#FF02772
for M1c• ES June 16 2-017
Revised 07/15/2014 7)398.0153 FloridallotaryServicrl,torn_, V•
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW .REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS