HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED ``
Date: �'� 7 Permit Number: )
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_ Building Permit Application APR 2:7 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
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Address: NO, 5Ic_c C1.19-
Legal Description:
Property Tax I D#: 3y q S I b - 0o 6 e MC>A r Lot No. G ?,
Site Plan Name: Block No. ` I
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional workto a Pe orme under t is permit-check a appy:
_ VAC �_Gas Tank ❑Gas Pig _Shutters ❑Windows/Doors
Piping
Electric 0 Plumbing FiSprinklers ❑Generator ❑Roof
Total Sq. Ft of Construction: w S Ft.of First Floor:
Cost of Construction:$ L4LA5_0 Utilities: _Sewer ElSeptic Building Height:
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Name T H a dre dho"JoLjsL.' Name:CVS r`is
Address: .7Iq S\'O” 't \ate. Company: RmZ_r-LcN� co`�
City: ?r.r-�' State: Address: 5-4r- 1�w Oltr,Fw--1 k- P , ,3iE I\1
Zip Code: 34�T_L Fax: City: ft>4 S-�- LVLT e_ State: E(_
Phone No. 7 56-9-7S I Zip Code: 3`M4 Fax:
E-Mail: Phone No. 77L -396-Ob23
Fill in fee simple Title;Holder on next page(if different E-Mail:C�ris @6\rner1C.0\nc;,r cis) Lc rn
from the Owner listed above) State or County License: GA co s-7 46 I
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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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 respec;s,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
WFri NTNG TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
irov ?nents to your property.A Notice of Commenceme t ust be recorded and posted on the jobsite
first inspection. If you intend to obtain financis It with lender or an attorney before
cin work or recordingour Notice of Commen nt.
40
°;•..• ature of Contractor/License Holdero•., m
nature of Owner/Lessee/Agent 9.... �,.
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ST TE OF FLORIDA a m< STATE OF FLORIDA - a z
C .LINTY OF ��= COUNTY OF a x0
2 �� O�
MEMM
The forgoing instr nt was acknowledged before w o= The forgoing instr t was acknowledged before . 9
this day of 20 LZby P �Z this day of 20 by z
C�T S
37
'e am�� Ch ! �' D � aoVm
(Name of person acknowledging) (Name of person acknowled ing)
2A
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(Signature of Not Public-State of Florida) (Signature of Notary blit-State of Florida)
Personally Known OR ced Identification Personally Known R Pro c entification
Type of Identification Produced Type of Identification Produced `
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS