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Building Permit Application
ALL APPLICAB INF MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED _ Date: I7 Permit Number: I O r a Building Permit Application Planning and Development Services MAYO 12`017 Building and Code Regulation Division PEW11TT111 2300 Virginia Avenue,Fort Pierce FL 34982 St. L cis C u y, FL Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residentiay PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line PR®P®SED IMPR®VEMENT II.00AT10'N: Address: 6I/ v� PC, �' GAS -� ;�� 3 4 9 S77 Legal Description: Property Tax ID#: qSfl Lot No. Site Plan Name: Block No. Project Name: Setbacks Front Back: Right Side: Left Side: DFOR!GLEIPTI®N 0'F WOR'K: / Ge✓L ci i �•rrti o �—� �I 10J C®NSTRUCTI®'NI INFORMATION: Additional work to be nertormed under this permit—c ec a appy: HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors Electric 0 Plumbing F1Sprinklers 0 Generator Roof Roof pitch Total Sq. Ft of Construction: S . Ft.of First Floor: c Cost of Construction:$ / Utilities: _Sewer 0 Septic Building Height: ®WNEW RAPERS— CONTRACTOR: Name Name: ir e_f--:. Address: 1041 c f i e Company: City: State: 'FL Address: Zip Code: 3405 5'_7 Fax: City: State: Phone No. 3 3gU SSU Zip Code: Fax: E-Mail: Phone No. 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. SUPPLEMENTAL C©NSTRUCTION LFE?N 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 wQ&or recording our Notice of Commencement. s Sign#t'ure of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder STATE OF FLORIDA STATE OF FLORIDA COUNTY OF t 1C�,1 , COUNTY OF The forgoing instrument was acknowledge before me The forgoing instrument was;acknowledged before me this j�_day of M 20( by this_day of 20 _by WN1 P-P,�A (Name of per on ac nowledging (Name of person acknowledging) c� (Signature of Notary Public-State of Florida) / (Signature of Notary Public-State of Florida) Personally Known OR Produc d Identification V Personally Known OR Produced Identification Type of Identification Produced Type of Identification Produced S. NIEL t�I vs KAREN Commission Norris ;4 ( al)Commission n FF t1 6�3mi on No. (Seal) v My Commission Ex Jun n Peres Revised 07/15/2014 REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW DATE COMPLETE INITIALS