HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: IS ,la 12 Permit Number:
Building Permit Application MAY 18 2017
Planning and Development Services
Building and Code Regulation Division PER(',fiITTIivG
2300 Virginia Avenue,Fort Pierce FL 34982 St. Lucie C nty, FL
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Se1ect from dropbox, click arrow at the end of lino
Address:
Legal Description;
Property Tax 10#: ( Lot No.
c
Site Plan:Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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itl a wEmil I I
or oWnG(asTank
rme un erPispermW-1a appy:
HVAC J ❑Gas Piping _Shutters El
Windows/Doors
E]Electric LJ Plumbing Sprinklers Generator Roof
Total Sq. Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ O1D Utllities:n Sewer Septic Building Height:
Name It- C Name: s
Address-_ -id ffpriv- Company: » tr
city: State:-7E7_ Address= YJ217
Zip Code: YAJCj6 _ Fax:-UL-,320g!0.0 City: Y State:
Phone No.��� � 7"� _..,.. Zip Code: Fax ?7� �j -t2L?
E-Mailno 4 C- Phone No 'r7 Z `$ 2-7ZS-
Fill in fee mole Title Holder on next page(If different E-Mail: (11 Gcvyf?GLC
from the Owner listed above) State or County License: d
If value of construction Is$2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: Not App!icable
MORTGAGE COMPANY, Not Applicable
Name:
Name: Name:
Address- 7Address:
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:
L
I certify that no work or installation has commenced prior to the issuance of a permit.
St Lucie County makes no represen
b1tion that is granting a permit will authorize the permit holder to.build the subject structure
which is in conflict with any appiicR le Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Please consult With your Home Owners Atsociation 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 financln&consult with lender or an attorney before
commencing work or record'=your Notice of Commencement.
SIgnatu ser/LeAree/Aggent Signa7t
ontVact5r/License Holder
STAT RIDA OF FLORIDA
x0v
COUNTY OF crr U-kc- t COUNTY OF 91 Lu C I Is,
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this,J 13 day of Ma .20 - __by
4 20 by this III—dayof I J
-e 6rossyy"n n'c
(Name of personacknowledging) (Name of person-dcknowledging)
I / .
�IA I /�
2�L auj—a 3K 2 4—u4�azs
- '
Signature of Notary Public-State of Florida) (Si azure of Notary Public-State of Florida
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced-_
Commission No.AF00 Commission No.FFQQ2aa---.'k
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EXPiRES August 7,2117
.�Ots Y EXPIRES Augutt 7.2017
Revised 07/15/2014 .22D-3*01M Ronda
(40 298-0133 FlorivallotaryServecv.cora
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS