HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: � �� Permit Number: '1 O5J C�13�p
RECE %
I p MAY Q 5 2017
a. 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) 462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PR_'OPOSEDdN . VEMENT LOCATIQN
Address: X- A%C C-vr pc'y:-r Sr L--UC-4e
Legal Description: LOf 11 g`D-cK 2-2- -&,v Zr- ` AXV, Uf,�vy- Z -
Property Tax ID#: 3 r ot 5i 0eo83 > ®cid / 1 Lot No.—A-_�
Site Plan Name: 9%*&K Block No. Z.7,
Project Name:
Setbacks Front Back: Right Side: Left Side:
- I
DETAILED DESCRIPTION OF WORI< ''
�i
D(vVIP—wy 7t't�1.1' s a 171.1 j 3dC ,�51 �Ljer;neer. i
CQNSTR,UCTION INFORMATION
Additional work to be performed under this permit—check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters '`4/indo'ws/Doors'-
Electric _Plumbing _Sprinklers _Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
FJ�
Cost of Construction:$ '2 Z d R— Utilities: —Sewer _Septic Building Height.
LESS
ON
r CONTRACTOR
,
--
Name de,fA At �r SCC Cr C Name:
Address: olO+ PA M �r L'c _ Company:
City: ami' Sr LLtic�-t e State: Address:
Zip Code: 4'2 Fax: i ff A City: State:__
Phone No. gni (01% z3%40 Zip Code: Fax:
E-Mail: Q WLf.STC:'Ol 'R) C 0AA Lin r CA AN 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.
SUFPLE_IVIENTAL CONSTRUCTION LIEN LAW INFORMATION _
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FLE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Ad d ress: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/ CONTRACTOR AFFIDVIT: Application is hereby made to obtain..a permit to.do the work and installation as indicated.
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 l will, in all respects,'perfb'rm 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
commenqMg work or rgcording your Notice of Commencement.
�C
Si u e of Own r/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
S ATE OF FLORID STATE OF FLORIDA
OUNTY OF &. �.x.IQ. COUNTY OF` 1.
The fqL ing instru ent was acknowledged before me The forgoing instrument was acknowledged before me
this S day of %. 20�� by this day of 20_ by
(Name of person acknowledging) (Name of person acknowledging)
(Sign atur Notary Public-State of Florida ) (Signature of Notary Public-State of Florida )
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced L SJOSe's PH BECK
Produced
=� (Seal)
Commission No. =ti YCOMA�I N#FF24179,® Commission No.
EXPIRES dune 27,2019
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
l—ev.7/2014