HomeMy WebLinkAboutBuilding Permit Application FROM :cast electric FAX NO. :7725699775 Apr. 30 2017 6:34PM P6
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED _
Date: Permit Number: • V! J
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)462-1$78 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
Address:
Legal Description:
Property Tax ID#: ! � C "rte?. .- C�) 1 C� G�CXJ-� Lot No.1 _
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side: _
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MINORa t
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00tporta wor o e rm un ert is permit—c eck a appy:
0HVAC n Gas Tank Gas PipinShutters_
8 �Windows/Doors
Electric 1-1 Plumbing OSprinklers Generator Roof Roofpltah
Total Sq.Ft of Construction: r� Sq,
.Ft.of First Floor:
Cost of Construction:S c�206 ' utilities:0 Sewer Septic Building Height:
i +t'• x 'Y 'F'o t �, :i't` .4
Name Gv► " Name:
Address- Company: 4
City' State:. Address: 2 i clr e
Zip Code: '�t7 4t Fax: city:—V e-co Luk State' 1
Phone No.. �f• ' d Zip Code: . Fax:
E-Mail: Phone No. �l'7
Fill in fee simple Title Holder on next page{If different E-Mail: , Ir4G' r .�,.•,�
from the Owner listed above) State or County License: l-e
if value of construction Is$2500 or more,a RECORDED Notice of Commencement is required.
I
SUPPLEMENTAL CONSTRUCTION HIEN LAW INFORMATION ;0 Y�
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: ' `Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone: i
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone: I
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 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 t 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:boom 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
commenting
work or
recording our Notice of Commencement. 4'
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Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor License Holder
STATE
STATE OF FLORID STATE OF FLORIDA,
COUNTY OF x1 e.0 1 COUNTY OF } ,
The forgoing instrument was acknowledged before me The forgoing Instrument was acknowledged before me
thistday of rvNn ,- `_, 20 41by this /-), day of i 20 It) by
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(Namerson acknowledging} (Name of person acknowledging)
i
�d
( natu e o dtary Public-State of 13brida) { ure of Notary Public-Sta� Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identifications,roduced,I
Commission No._ � .(Seal) Commission No. ,b'<<,�= rage LA
cav/y t << �.y. N
1 °Ks `'d<' LASHA # U* ¢ Notary PublictNGRAM
No HNA iNGR ', r My Co State
y Comm EX of
fate of FlOrtda ''�9,i1i1'��``,� ���rOn
Om res DeC 2Q 2018
mISSIO <
Revised 07/15!2 4'' Q;;F°;:�� Commission'#D 1770,2018 Bonded thr 293
VO Assn.
REVIEWS FRONT ZONING SU �R - PIANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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