HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED U
. Date: 5 Permit Number:
RECEIV70 A R p 2017
Building Permit Application
Planning and Development Services
Building and Code Regulation Division J
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 Sh%)-ttc f'
PROPOSED IMPROVEMENT LOCATION: T
Address: CO � Co 2. 1 LLOQ" 12Y R. 34949
Legal Description: r-v GQ Z{ A--e' 2-9 ( Unuc
Tr- tt,,' r 'bawl (Lo -_o
Property Tax ID#: 1`1 I U�0 2 0'2_q I booq Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED'D:ES"CRIPTION OF WORK:
ak_r-,,(Dlcordk n
CONSTRUCTION INFORMATION: "
Additional work toa performed under this permit—c ec a that
ply:
HVAC 11 Gas Tank F]Gas Piping a Windows/Doors
Electric ❑ Plumbing Sprinklers El Generator Roof Roof pitch
Total Sq. Ft of Construction: ^� S Ft. of First Floor:
Cost of Construction: $ D oo. Utilities:Sewer[]Septic Building Height:
OWNER/LESSLE:' ry CONTRACTOR:
NameLC,.p Name: rnQ S L T'easz
Address: 157344VL>DV Company---:FJpY'k CIO c�{'ym-f+ .1"s I n C,
City VzA- y-c-e. State: Pl Address: k'dS�s �AMn'iQf'CSL vrz
Zip Code: 9 Fax: City: \f4.2(`') G h State: art.
Phone No. UQ� J Zip Code: X29 (p C) Fax: (---'2,) 50-N-14
E-Mail: Phone No. ( - -2o
Fill in fee simple Title Holder on next page(if different E-Mail:(J2n 4 In-Q Ti
from the Owner listed above) State or County License: (21e)(21C22)C Ok s�
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL-CONSTR'UCTION 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 Commencegnent 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
comm work or recording our Notice of Commencement.
1s
Si nature of Owner/Lessee/Contra or as Agent for Owner Signature of Contractor/License older
STATE OF FLOSTATE OF FLORIDA
COUNTY OF � w COUNTY OF
The forgoing instrument was acknowledged before me The forgo-ting instrument was acknowledged before me
thisday of 1 r�, `C¢rc , 20 1-1 by this day of GL Y e-t l 20 V-I by
o+- ce s L. �� nr�rta5 L
(Name of person acknowledging) (Name of person acknowledging) ti
IILL ZW\Q A,
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known �-' OR Produced [dent' is tion Personally Knign
Type of Utu Type of Iden fi c14M&,oduce(
p1uuiq
gt,.is'pga'% DEBORAH EMERICK .-- - "i
Commi Q Notary Public State a Ngtary Public-St of lorida
Qksugl Commission b-+ mmFssion# �42
'.
s Commisslon #FF 96694 "', My Comm.Expires Mar 20,2020
My Comm.Expires Mar 20,2020-
Revised 7 15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS