HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Permit Number: C)5-j
Date: R E C E I V'_:D ".I 3 2017
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Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)4624553 Fax: (772)462-1578 Commercial Residential V/
PERMIT APPLICATION FOR:
PRaPCSED T,
Address: ?>0
Legal Description:�
Property Tax ID#::3 Q02--b0z 915 000 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional work to be performed under this permit check all that apply:
—HVAC —Gas Tank —Gas Piping ZShutters' ZW!ndows/Doors
—Electric —Plumbing —Sprinklers —Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 121 !qQ042-0 Utilities: —Sewer _Septic Building Height:
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Name Name: V3
Address: Of-\I V.,_ Z Company: e V y
City: ro\1-7� State�� Address:
Zip Co e: ---*
0- Fax: City: t-A % � State.-_ V-7L
Phone No. t/Ina— qb!2- y Zip Code._�14 Mi Fax:
E-Mail: Phone No.(N*-�)i ?>�24Y23
Fill in fee simple Title Holder on next page(If different E-Mail: 6,1rAivito6f np etrt-lyp5t WeT_
from the Owner listed above) State or County License:7C r-t-C
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPFLEM�EN� AL COI�STR�I�TIQN tLIE�I 1�V�IN�ORMAT�a�V. p�� Ns � ;«� �` ° ' ,
DESIGNER/ENGINEER: NotfApplicable MORTGAGE COMPANY: Not Applicable
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 Nome 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 1 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 work or recording our Notice of Commencement.
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Signat a of caner/L ssee/ n Tactor as Agent for Owner Signaturbdf Contractor/, i6enfetMer
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF �. LLSC�•`t�U COUNTY OF_
The forgoing instr ment was acknowledged before me The forgoing instrument was acknowledged before me
this' day of . 201by this day of V_ 20 by
"a X70 ' c Q�\'�
(17 me of person ackn wledging {Name of person a knowledging}
a C&
(Signature of Notary Pu 'c-State of Florida} (Signature of Notary Publi State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Pro4u,—J ._
V�'cr� MA pE A Z VELA3G0 ,;�i'3'`In' MADE LA LUZ VELASGO
Commission No. (( e Commission No. CpMMISSW�#GG050388
Y C4MMI8$FON 9 p(3050399
EXPIRES 28,2020 EXPIRES November 28.2020
November
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS