HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:_b11 Permit Number: 4" 03,a�'d•�
—T RECEII`rD PEAR 2 9 2017
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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: To Select from dropbox, click arrow at the end of line
.,PROPOSED IMPROVEMENT LOCATION:
Address:_RA6'`J R'0e6'0. wsy Ran— Luc..r- a.
Legal Description: �ob is �T- ��sec-y e- Pukt i� G R 4O-Ib) C.oT�or MCA 154
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Property Tax ID#: 33a]— 7 I l—DO31 boo_a Lot No.?4
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
Ac o Lx - Remove y T A) - res rArLL Ncw`rkme qTDN Q geet-
U'k6EEIR, -9.00 RS?F A STP-2e. tk0zT-aaw.p. Us*gNj OlEe-- ic,
Co jger V-vw-S- ADDGD New 51 pa To ri Lkt\ aur er'.s 1A I n9 Bak STgnD.�A.r NanD�CC,
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CONSTRUCTION.INFORMATION:
�Additional work to e e orme under this permit—check a appy:
LJHVAC
Gas Tank []Gas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing Sprinklers I Generator F]Roof Roof pitch
Total Sq. Ft of Construction: S�Ftj of First Floor:
Cost of Construction:$, J�DD,�O Utilities"nSewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name&&, _, MaAk %ce. Name: EDwRP-b W• (`Krer►W;n
`1 � iL ;Address:&I(0o
City: ?6rTSA1,n t tL`ie_ State: ¢L Address: 353 NW BI4v3lnorc. A1ub
Zip Code: 3448'4 Fax:_ N_ /�7- City: perm Sowh-I- LLtc.i r Stater[
Phone No.77o't-3b1-7&6D Zip Code: 3qCc$3 Fax:77oL-,13l.)-0(6q
E-Mail: Phone No.qS-q-t05$ -7(x'90
Fill in fee simple Title Holder on next page(if different E-Mail: The PSC,jtw),I..Q Qmo,�A.CDwt
from the Owner listed above) State or County License:ST&TE- C11.'M 7$1;
161-3
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 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 Commencement.
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Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/ cense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF .moi: Luc.e-- COUNTY OF ST'.bAC,,e_
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of Mit LC.}n 20 Eby this IR-day of jnry,1% ,20 L—I_by
(Nam of person acknowledging) (Name 8f person acknowledging)
(Si ure otary Public-State of Florida) (Sig26A of lVotary Public-State of Florida)
Personally Known OR Produced Identification / Personally Known OR Produced Identification
Type of Identification Produced 1ViVf-3 I", Type of Identification Produced Drit Der$ Oc tna-e�
Commission No. bIO&0 io ission No. C& 61560( (Seal)
#W pu Notary Public State of Flor
r . t'
Dyllan Jones
nG 0186111 Y Notary Public State of Florida
YOor f%.e Expires 08!04!2029 Dy an one
Revised 07/15/2014 Qa. My Commission GG 018691
or F,o Expires 08!04!2020
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS