HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED J
Date: 491 Permit Number:
"ImCEIVED
MAY 112017
yu, ►.
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:
PR0'POSED INP'ROUEMENT LOCATION:
Address: 0-3 D'� e2df(e–yoVICE- -Ave
Legal Description: �c+.r�(' l�i� On Ck
Property Tax ID#: J43 3 -- Q)Q)I a/3a -pnn— / Lot No. o�
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
L DP Df m"I QKNI OF WO M K.
Or mo IV,
COIRS STRUC ION INFO MATRON•
it onal wobepertormed unclertfili 0&ffiit–checK all that appy:
_Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator Roof Pitch
Total Sq. Ft of Construction: Ell Sq. Ft. of First Floor:
�� ��yrr .00
Cost of Construction:$ �Y,4LE) Utilities: —Sewer _Septic Building Height:
OWN �R CONTRACTOR:
Name . - ! 61Zt rr Name:
Address: �ln�� lt)� 2� '5: ::} 1�� Company;`' �\
City: ( eh Y-r p State:f� Address: � e (W
Zip Code: Fax: City: �r 2, State:
Phone No. Zip Code: Fax:
E-Mail: Phone No Z
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or C my License (?�C
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUP'FLEMENTAL CONSTRUCTION LIEN LAW fNFO'RMATIO'N:
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:
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 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 work or recording our Notice of Commencement.
Signature of Owner/Lessee/o rttflakctor as Agent for Owner Signa ure of Contra ctor/Lic se Holder
STATE OF FLORIDA //' STATE OF FLORIDA
COUNTY OF e COUNTY OF ,�
The forgoing instrument was acknowledged before me The for oing instrument was acknowledged before me
this lel/
day of t/ 20J by this /(a` qday of 20Z7 by
(Name of person acknowledging) (Name of person acknowledging)
gnature of Notary Public-State of Florida) ignature of Notary Public-State of Florida)
Personally Known_ OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced JOHNNIE HILLS,SR.
pBY Pue JOHNNIE HILLS,SR. ,� , * My COMMISSION#FF 211362
Commission No. o EXPIRgSdd�118,2019
*(�i�'zf�MMISSION#FF 211362 Commission No. �Nj
EXPIRES:July 18,2019 AOF F��\ Bonded Thru Budget otary Services
Bonded Thru Budget Notary Services
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014