HomeMy WebLinkAboutBuilding Permit Application From:Bailey Whittemore Fax:(800)757-0066 JVTo:- Fax: (772)462-1578 Page 2 of 5 04/26/2017 11:53 AM
ALL APP CABL�INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED u C
Dacey '�� 1 Permit Number: 1� 1'os
RECEI�I�D APR ? 6 2017
t.:
Building Permit Application
Plannfng and Development Services
Building and Code Regulation Division v
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential X I
rPERMIT APPaLICATIOcN11 FOR: To Select from dropbox,click arrow at the end of line �v C�C,
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Legal Descri ci.o
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Property Tax ID#: L L r ('tt- l AJ�S t' �1 �" Lot No.
Site Plan Name: Block No.-...._____._...
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Plumbing Sprinklers �Generator F]Root Roof pitch
Total Sq.Ft of Construction: CC S .Ft.of First Floor:
Cost of Construction:$ q)r��-C�, Utilities: Sewer U Septic Building Height:
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Name Name:
Address: _ Company: -
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Zip Coder Fax: Clty: fi Cil' State:�1
Phone No.`��7 �((6'q6113% Zip Code: ?Mg-T191 Fax: t-q a ID-9
E-Mail. Phone No. t -
Fill in fee simple Ti tie Holder on next page(if different E-Mail: ).
from the Owner listed above) State or County License: ' " qS .
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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From:Bailey Whittemore Fax:(800)757-0066 To: Fax: (772)462-1578 Page 3 of 5 04/26/2017 11:53 AM
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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:
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I certify that no workor 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 subjectstructure
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 ofthe 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 fallowing building permit applications are exempt from undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessary 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 ur Notice of Commencement.__...
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Signa ure of Owner/Lessee/Contractor as Agent for Owner Sigriliture of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S�. Coa e— _ COUNTY OF S Ir• Iy(1 .._The f oing Inst mentwas acknowledged before me Thefor Ding inst ntwas acknowledged before me
thisayof_ C'\ 20 by thisdayof 20 ,_by II
"R116M.1- Wind �rn , i ,c t�arc� t Ohl 4 l e_ir .
INamee of person acknowledging) (Name of persso�n acknowledging)
16Q ^ ULc ae —
(Signatu f Notary Public-State of Florida) (Signatu f Notary Public State of Florida)
Personally Known—�O—OR Produced Identification Personally Known_r_OR Produced Identification
Type of Identification Produced Type of Identification Produced
�lY NOLE
KEILYKI
COa155Ndd FF 4273?
Commission No.Pew, 3;;) 7eat) Commission No.Fv/'q�
C HMYMMENILM EXPIRES:Augus!5.2018
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Revised 07/15/2014 ''`FernV ModIDTAWFINotiryscalcea
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE {
COMPLETE
INITIALS