HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a3 Permit Number: 11d — dTkG
MENEM -0 RECEIVED MAY 2 3 2017
Building Permit Applicati®n
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: To Select from dropbox, click arrow at the end of line W4w'A t,�
PROPOSED IMPROVEMENT LOCATION;
Address: ( Ill Ian'I.r
Legal Description:
Property Tax ID#: 6 2 g 3 q �56b dZ C ` Lot No.
Site Plan Name: Block No.
Project Name: 1`�r���M-r—m�r
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF'WORK:
L, 140tiq
1 1-6-0-Vn4ZLi
CONSTRUCTION INFORMATION:
Additional work toe e orme under this permit—check a appy:
HVAC E]Gas Tank E]Gas Piping _Shutters Windows/Doors
11 Electric 0 Plumbing Sprinklers Generator _Roof Roof pitch
Total Sq. Ft of Construction: cc S Ft.of First Floor:
Cost of Construction:$ J 6 Utilities: Sewer Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name nk_ OAC tM-C sl-CY Name:
Address: t¢Gi ( e ItNt)h IM< IC V d Company:
City: —o a tYiYC-r_ State:r'-6 Address: t'g Q�)Y b'fa
Zip Code: Fax: City: % n kO-n State:
Phone No. Zip Code: 23Ll!Z(e Fax: OG(0&-y
E-Mail: Phone No. `7 b CC
Fill in fee simple Title Holder on next page(if different E-Mail: GUYGVI 5��( t 6(S Gm
from the Owner listed above) State or County License: C t3�I G�17 Z
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN_LAW INFORMATION:
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: -
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 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
com.(nencing work or recording our Notice of Commencement.
c--rJ -Pr►'�-e ✓�
_ s _
Signature of wner/Lessee/Contractor Js Agent for Owner Signature of Contractor/License Holder
STATE OF FLO A i STATE OF FLOR ,
COUNTY OF . COUNTY OF
_ Alli
The forgoing instrurpent as acknowledged before me The foLgoing instruknowledged before me
this . ay of. 20)�by this T day of m was a 20 7%y
1 �
(Na f per.*acknowledging)) (Name of person ac
k Iedgigj
AA
(Signature Notary Pu f Florida) (Sig ure of Nota ub' -State of Florida)
Personally Know OR Pr uce dentification Personally Known _ ' 'cation
Type of Identific Ion,,rp, Type of Identifica icy: _cedAEllthi
y pia:' GIS$IA C.MAF)TIH�g = (viY LUti1M15S1QN#FF902810
Commission No. ''?w•= d�i !2019
Commission No. * otary Bau'41SOA&®1 Fi9rida EXPIRES J )
roc y Comm.Expires Oat l'A.2017 ''Q�i ass o's3 r�oridoNoia 9et1 aom
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COMMW
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS