HomeMy WebLinkAboutBuilding Permit Application i
All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: )
RECEWED
MAY 19 2017
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: e
W, _ 1
P ��OPOS �D INPR+� E,/MENT LO ATIO
Address:/$0 5 d D.e.7VF-
Legal Description: I� ��,' f- S�afPs o�
Property Tax ID#: s• Lot No.
Site Plan Name: Block No.
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Project Name:
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Setbacks Front i Back: Right Side: 0 Left Side:,:2 0
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CONS R C 10 NFOR ATION:
YOUffional worK to be performed under t is permit.-MR a that appy:
_Mechanical _Gas Tank ` _Gas Piping _Shutters Windows/Door's
Electric I . _Plumbing _Sprinklers —Generator —Roof Pitch
Total Sq.•Ft of Constr"auction: Sq. Ft. of First Floor.:.
Cost of Construction: $ / $ C6 Utilities: —Sewer Septic Building Height:
0W ER/LE�S�S E. CONT ACTOR•
Name Name: u r1
I .I
Address: l gQ �znlwocl ��_ Company: ��,/Gge �c� Far7rn� S ,ec s
City: Al�fState:_ Address: 3 Oo /U_ LeS I
Zip Code: Fax: City: /2"erce State: ~�
Phone No. _ 3-11- Zip Code: 914 941 Fax:
E-Mail: Phone No -7 7�2-,21h"- '4,' 2
Fill in fee simple Title Holder on next page (if different E-Mail �2,,LL d e S
from the Owner listed above) State or County License C GC& I,�"Q 7ZS'g
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTALC«ONSTRWAR ION LIEN LAW INFORMATI{s
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/ ontractor as Agent for Owner_? � ;$(gii ture of Contractor/License Holder == .......
STATE OF FLORIDA
.$Ti TE OF FLOR m
COUNTY OF - a `> B NTY OF
• 2 1� 2 77Sq
T
The forgoing ins ument was acknowledged before me -` _fff�-.or oing instrument was acknowledged b o'e
thisday of 20�]byh day of 20
T 2
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c 9 n NV
N < �]
ry N N
(Name of persona nowledging) a of person acknowledging' W"L2AJAA
)
':�L /J
(Signature of Notr Pub' State a u
of Florida (Signre of Notary lic-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014