HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �`= J Permit Number: 70V -I)
RECEIVEDx
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: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT L®CATI®N:
Address: 1W G CJ` Po GtJ'
Legal Description:
Property Tax ID#: d5 30 r'`6/f'-6 I-Tk— 0(7C7 s Lot No.
Site Plan Name: Block No.
Project Name:mA
-mm
Setbacks Front- Back: Right Side: Left Side:
111EXEMITA.
I ED DE�SCRdPTION Of 1NOR'K:
CONSTRUCTION I'NFORMATI`ON:
itiona wor to De ne, orme un er Ms permit-c ec a apply:
HVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
Electric ❑PlumbingSprinklers .E Generator 0 Roof Roof pitch
Total Sq. Ft of Construction: S . Ft.of First Floor:
w�
Cost of Construction:$ 7-� Utilities. _Sewer _Septic Building Height:
OWNER/LEM EE: C®'NTRAC«TO
Name o6 rT 4bI✓aJ- Name: C aJ' �• Com'-�G�, t
Address: G70-7 ®GieCo 4-4:>° Company: rec
"-S°h jf/tc-�J+ec-/ rn rELC
City: ErT Ai crC 2 State: Address:_� G_ 1?0p 6So PeRy
Zip Code: Fax: City: yov-d 0,-,Fd :
d State
Phone No. 799'o Zip Code: _74C-5- Fax:
E-Mail: Phone No. e772) _?2/- 70cl y
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUFPLEMENTAL CONSTRUCTION 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 thepermit 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.
Signature of Owner/Lessee/Contractor as Agent for Own =,�;o.,... i ure of Contractor/License Holder , '
STATE OF FLORIDA a S TE OF FLORIDA i x
COUNTY OF '' a X UNTY OF 2
v o m=
Z M, ° ��
The fro�r, ping instr ent was acknowledged efore me "' forgoing instru nt was acknowledged before me w z'
this L —day of 20 � by w -&day of 20 by T
T
rr
(Name of person acknowledging) (N a of person acknowledging)
(Signature of N Vry Public-State of Florida / (Signature of Notary P blic-State of Florida)
Personally Known-OR-Produced Identification Personally Known OR Pro uc d Identific tion
Type of Identification Produce - Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS