HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED'
Date: - 27+ ( � Permit Number:
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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:
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PR@POSED INPROUEMENT LQCATIQN t = °, I ¢' ` , =, k
Address: CJ 107 AM b6(o t-,k�
Legal Description: w�c`ik�- �;c96'lt E:5tR&5
Property Tax ID#: 3 402 &(0 - o 4c5- Q®o-2 Lot No. 35
Site Plan Name: Block No. (?4,
Project Name:
Setbacks Front Back: Right Side: Left Side:
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IDETAILED DES17
CRIPTION=AE 1NQRK
CONSTRVCTIQ ' F0� ON, 4 �I
A rtiona wor obepertormed 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:l'
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Cost of Construction: $ Utilities: _Sewer _Septic Building Height:
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C?111� IEFt/LESSEE# �° " Lir k` n a n CONTRATTOR: " } `
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Name5D0J ��11;�5 Name: %`( L<t( b ccrXzt ...
Address: &(b A".04 Company: l-A+A*f Ip061L
City: raa State:_ Address: (16 5, 46L-
Zip Code;_ Fax: City: State: Z
Phone No` " Zip Code: 3�-�`f� Fax: 32� 26y 7�c[6
E-Mail: Phone No 12 (- Zb`I &34cl
Fill in fee simple Title Holder on next page( if different E-Mail
from the Owner listed above) State or County License 139, 9'903
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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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 covenant's 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 you paying twice for
improvements to your property. A Notice of Commencement must be recorded and on the jobsite
before the first inspection. ou intend to obtain financing, consult wi I n .led
torney before
commencin w ,re n our Notice of Commencement.
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Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDAe ,, STATE OF FLORIDA
COUNTY OF COUNTY OF - �),.-LLt J ,�,
The forgoing instrument was acknowledged before me The orgoing instrument was acknowledged before me
this,�1 day of �� 2017 by this day of Yy%,i,,r,) 20n by
(Nam e,of person acknowledging) (Name of person acknowledging)
gnat6f6 o"f Notary Public-State of.Florida ) (Signaturer0' Notary Public-State of orida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
_Eraduced Produced
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Commission No. (Seal) Commission No. (Seal) .
REVIEWS F:O C� SIiAN��lr)� � � PLANS EC� ,�r ,10 L , jIAM NGROVE
CO �,NT ;f 9'�'�oRE�(� W?ublic-std€°I�018 i REVIEW � Not ry PUi�I e-of FI rida VIEW
DATE ;2°v any comm•c FF 177249 t++ '• + Y mm.Expires Dec 20, 018
RECEIVED m °# I '�° `�`= C mmission#FF 1772 9
�,j s•+ �: Com issi °nal Notary Assn. leo �o�•`.
DATE J
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COMPLETED 1'
iev. 7/2014