HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1
Date: LA � m Permit number_ Ll
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RECEIVED APR ? 7 2017
Building Permit Application
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°1�11R�1MElT1.00ATIO 4L ;_
Address: -756;,
Legal Description:
Property Tax ID##: ZP_kA�1 kA_G71�" ���`�� —�— Lot No. L
Site Plan Name: ^� LC Block No.
Project Name:
Setbacks Front Back- Right Side: Left Side:
DETAILED DESCRIPTIONF WORK.
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COlST1C�lo�l II�lC3Rt�JIATION ,
Additional work to be performed under this permit—check all that apply-
-Mechanical
pp y-_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator V__Roof
Total Sq_Ft of Construction: Sq.Ft_of First Floor_
Cost of Construction:$ 7�000�•/�!� Utilities: _Sewer _Septic Building Height:
Name Name:
Addre : Company!
City: WD rt 9�t W 44?1 State_. Address: .6
Zip Code:. Fax: � City: State:
Phone No. 77Z-.530-LWO N Zip Code:7X 448 Fax=77Z-S&S;-03&-
E-Mail: Phone No?7L--Ci66` t9e,-S'"
Fill in fee simple Title Holder on next page(if different E-Mail �U��A
from the Owner listed above) tat County License eZL 0.T'7-s
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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JS[�PLEiVfE�#TL{�QS E li� 3 ��� LIEii!
DESIGNER/ENGINEER: `V _M1Not Applicable MORTGAGE COMPANY: _Wot 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:
rAddress: Address:
City: City: i
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 vAth any applicable Lorne Owners Association rules,bylams 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 eirith 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,ss:simming pools,fences,vralls,signs,screen rooms and accessory uses to another non-esiden`-ial 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,consuk With lender or an attorney before
commencing work or recording your Notice of Commencement.
Signatur Oevner/Lessee/Agent Signature Contractor/License Holder
STATE OF FLORIDASTATE OF FLORIDA
stThe5-
COUNTY OF C . L O c � COLIti1TY OF 7S!k , 1-y C:\-,-
The
folgoing instrument was acknowledged before me The 10 sing instrument was acknowledged before me
thisa. day of `!t,N ,20 11 by this day of 20AI by
q & L ES C S-q av nN-g� t--A{S c j— °
(Name of per on acknowledging) (Name of person acknowledging)
(Signature of Notary Publ State of Florida) (Signature of Nota ubiic-Stade of Rorida)
Personally Known OR Produced Identification _ rsonally Known OR Produced Identification.
Type of identification pe of Identificati
Produced t— �--.
pG02202 P UCe
EANNAMARIE GIVENS '+ ,s DEANNA MARIE GIVENS I €
COMMISSION# G
:*; ;,t? ON#GG U22D23
IRES:Dere miler 1 6,2020 PIRES:De 2121
Commission No. (� �?hruNotaryPublicUnderv+lei mISSIOn iil0. dThruNota c nderwritar
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION 1 SEA TURTLE MANGROVE
I COUNTER REVIEW REVIEW REVIEW i REVIEW REVIEW REVIEW i
DATE
RECEIVED
DATE i
COMPLETED
ke—v-7/2014