HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Number:
ED �J
Date.
VED
RECEJ
Building Permit Application SPR '1 2017
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:
P ,®POSINPF 0 MITs(FCATj' N —
Address: .53 G,� �( i Cko rk, ' e'-
Legal
tiLegal Description: t2 6 h 9 T - (� �� s�' r! 7 / C Yn t4 P 3 l( 62S CR S(
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Property Tax ID#: O t' . 0: o(S Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front —Ba ck: Right Side: Left Side:
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Additional wor to be performed un er t is permit-c ec ail tat appy:
_Mechanical _Gas Tank _Gas Piping _ hu ters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ Ic`3 20 Utilities: —Sewer _Septic Building Height:
Nob"
Name
�•rLen re (nom
1'( 0 r\ Name: �D.
Address: S 3 0 G C (C Cf 6 i^ Company: V
City: F-rOt^z v'-C,- - State:Fin Address: I a SG{nSz T ify
Zip Code: 31-( T S '- Fax: City: r P(�Qr cr- State: T-'(n
Phone No. 331 Zip Code: 3 [('�8Z Fax: 7?2 u 63 ?aQ7
E-Mail: e— Phone No —�'1 2 (S -3 °l66
Fill in fee simple Title Holder on next page(if different E-Mail �—
from the Owner listed above) State or County License C to C 13.97 X 1l
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: Vot Applicable ANY
:
_I
/I loot Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: of Applicable BONDING COMPANY: _ of 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 Commencement.
l
Sig ure of Owner/Lessee ntractor as Agent for Owner Signatu f Contra or/License H61der
STATE OF FLORIDA 11STATE OF FLORIDA
COUNTY OF s t' l -�� >✓ COUNTY OF
Thefqr oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this (4 day of 1 =20_4 by this�day of_��� ,20� by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public State of Florida) (Signature of Notary Pu lic-State of Florida)
Personally Known_ OR Prg uu fication Personally Known_ OR Produced Identification
Type of Identification NOTARY PUBLIC Type of IdentifiWo p MOM
Produced FLORIDA Prod
Commission No. w` C (F Co S'PATt;t�FFLOt`tIDA (Seal)
' � Ire 111612
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.7/2014