HomeMy WebLinkAboutBuilding Permit Application All APPLI'CA1BLEIINFOrMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ►�(
Date: Permit Number:
Building Permit Application
Planning and Development Services i ,
Building and Code Regulation Division '
2300 Virginia Avenue,Fort Pierce FL 34982 1 1 2017
Phone: (772)462-1553 Fax: (772)462-1579. PERIMITTIMG
Commercial ResidentialAPR
PERMIT APPLICATION FOR: St. Lucie County, FL
PR®POSED IN�ROUEMENT L®CATI®N:
Address: — l• V • S• W
Legal Description:
Property Tax ID#: —�� V�' ` eG Lot No.
Site Plan Name: Block No.
Project Name: 4 �1— � 1 '� n 10 1 � P
Setbacks Front Back: Right Side: Left Side:
DE AILED DESCR4IiPTION F WURK:
G1
CONSTR�l1CTIQN 1NFQRM1aTI0N:
Additional wor to be pertormed under this permit—check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
TotaliSq Ft1of Construction: .I Sq. Ft..of.F:irst;-F.loor.:
Cost-.of,;C nstruction: $ 1300 . u U Utilities: , _Sewer'; -:9:Septic Building Height:.
OU1t ER/EEASSEE: �NTKjA 'R:
Named �^
k ��
Address Com an �. Ti
p y..
City:," i�71 V State: Address ' �Pr TO
Zip Code: gL4Lo• Fax: City: 2 1 �a w Stater
Phone No., t ,,� - / Zip Code: J� L Fax:
E-Mail: C�umPP�'((� VIY��I��� Phone No
Fill in fee simple Title Holder on next page(if different E-Mail L( Ga ' true t( gcj.na �p� `
from the Owner listed above) State or County License MC.1 SS
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
S� 'P�PI�EI�IE TAL CaNR 7Fil1.C�T10N LN l.A1N INF®RMATION:
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 Commencement.
ignature of Owner/Lessee/Contractor as Agent for Owner WSign.ature Contractor/License Holder
STATE OF FLOA STATE OF FLORIDA
R
COUNTY OF l L_uc,e__ COUNTY OF 'S-t- L U(-
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this l l day of_Ar s b 20117 by this_L11 day of 201-7 by
C'1nC�� 5• lG`�l v�✓'� C Ll.GL� S • �Gt.rt r��G
(Name of person acknowledging) (Name of person acknowledging
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(Sign ator-e-ofNotar-y-Public=5tata of_`1 id��bM�SS1�N.,•. �i� (Signature of Notary_Public-State of Flori a I��°�QN,�..�•��
g�oN EXP/9�
Personally Known OR Prod��dlc�t°�tificatio�9c�: = Personally Known OR Produced Ic�rfil �'20ry s•
Type of Identification = all•�e *� Type of Identification ? ;V o •i
Produced l�cz,tse, oFF201750 Produced ;mow
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Commission No. Sy i� �c�:�`�•'• `
au, iiy STATE Commission No.
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
-COMPLETED
ev. 7/2014