HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED t1
Date: )i to Permit Number:
RECE1 TD APR p 4 2017
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 C/
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential '
PERMIT APPLICATION FOR:
RRK,KWS D IN°PROVEMENT L®CATIO'N:
Address:4r�2�
Legal Description: JUS' 5 ® fir -J t" R16C.
Property Tax ID#: '�L�oa,. a1- da�9- ��� ", Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side:_ 5 Left Side:
DETAILED DE�SCR+LPI'LON OF WQ'RK:
a-
ree
CQNSTRUCTI NS LNFORM TLON:
Additional work to be performed under this permit-check all that appy:
_Mechanical _Gas Tank- _Gas Piping _Shutters _Windows/Door's
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: Utilities: _Sewer _Septic Building Height:
N0,1ER LESSE ®'NTR#A TOR:
Name Name: 21`l i Ft I IrL5
Address: D : Company: )&.1pl,O .i rlJ CCSy\�S
City:E2 Jef G r 0-`i State: )f'i 1� Address: S167i i t CA,I,
Zip Code:�`���C( ��-- Fax: City: - r State:
Phone No. � al Zip Code: /-
E-Mail: Phone No l '- �(D OZ'KS
Fill in fee simple Title Holder on next page(if different E-Mail P irr�`�1-�/L.y` 9 ®� M'!x-:J l�
from the Owner listed above) State or County LicenseSCP_5 $ro r y
L
value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SU► PPLEMENTAL NWNS 'ill 1 1'®N LIEN -UU IN'F®RI�/IATI®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 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 Commencemen
Signature of Owner/Lessee Contractor as Agent or Owner Signature of Contractor License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S k . Ly c��� COUNTY OF S k• L c �@
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledge before me
this day of <�. P t 2011 by this�day of C%-ft by
t
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pu c-State of Florida ) (Signature of Notary Pu c-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced '� L Q L Produced "t L. QL_
Commission No. f�F_7%6qlCo , (Seal) Commission No. I!e=E"<ST1?0 D (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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