HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECEIM U,.
Building Permit Application APR 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:
PROPOSED I�NPROVE(t/IENT LQCAl'[
Address: �L{ H GK 0R I
Legal Description:_±1. IGS" ✓F.e- S'A fc,j V a' fi ~ 08 ^ (31 k S 3 L0+2 17-
(401 34 r r A/ -3542 -1100
Property Tax ID#: 3 2— 6oq.--0205 —000—9 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETIA__ILR- DESS'RI+PTI -----------------
ON OF WORK:
CONSTR+UCTI:Q. IiNFOR TION:
Additional work to be per orme un er t ss.permit-checHll that appy:
—Mechanical : _Gas Tank _Gas Piping, _Shutters s ,Windows/Doors,.
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: $�� -Sq. Ft.of First Floor: 'n�t
T
Cost of Construction,: $ P? Utilities: _Sewer _Septic Building Height:
OWN ER/LE��SEE. CONI'RAC1'Q'�R;
Name IaP Wk 5-0 Name;- S o
Address: d,'54 11 H iG0rL- Company: G 94-9
City:_a� Ude i°�iei'�Q State:(-f L Address: �1912- ILYiGw S"_
Zip Code: tv
4q $Z- Fax: City: Stahel
Phone No.c' Zip Code N� R 3 Fax:
E-Mail: Phone No)-�3Z-3 - 3318-3
Fill in fee simple Title Holder on next page(if different E-Mail ('C'a.C.
from the Owner lilted above) State or"County License 2 92-50)
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SIJPPLEN�NTA�C®NSTR4l1'CTY®N LlN LAUD INF®R+NATION:
DESIGNER/ENGINEER: of Applicable MORTGAGE COMPANY: _ of 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 holderto 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
encing work or recording our Notice of Commenceme
Sign ure of Owner/Lessee/Contrac,o6 as Agerit for 0v net Signature of Confraetor/License Holder o
c E OF FLORIDA STATE OF FLORIDA Z m �
EO NTY OF COUNTY OF P?cn
Z542
wox
going instrument was acknowledged before me The forgoing instrument was acknowledged before me �T
101 aday of 20" by this_a day of 20%� by a m
N �nc � fVn_ gen C_
ame of person c nowedgin (Name of person knowledging)
(Signature of Notary Public-State of Florida) (S gnature of Notary Public-State of Florida)
Personally Known / OR Produced Identification Personally Know OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission No. - (Seal)'. Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW -REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED .
DATE
COMPLETED
ev. 7/2014