HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �1
Date: Permit Number:
_.�.'"t.� w*i. -,...-
RECEW713 JUN 0 9 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 I/ Residential
PERMIT APPLICATION FOR:
P'R®.POSED hN!PRO�hEn/IhENT L.00AION:
Address:
Legal Description: ,�
Property Tax ID#: �a = 'aw-ad p do 0 - s- Lot No.
Site Plan Name: V 4AI I)QV/V (r- &R d UNS Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILE® DE.�SGRIPTION 0'F 11,11
WORK: ..
C0 STR=l1CTION 1iMF®RMATI,®N•
Additional work to be pertormed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric —Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: Al
It
Cost of Construction:$ (90176 . 06 Utilities: —Sewer _Septic Building Height:
OWNER/LESSEE:EmilCONTRACT Of
Name ��" Name:
Address:_, 4 LL) R-Gd C Company:
City: ,( d /�4I'dz• State: Address: 11,91-4
Zip Code:_ ���/ Fax: City: ^ L. State:/ Zl
Phone No. Zip Code:,Y�{'�R,? Fax: 77A l 79M
E-Mail: Phone No
Fill.in fee simple Title Holder on next page(if different E-Mail CC: 6 t/ 4416c, I CdA
from the Owner listed above) State or County License CG CGS A 3 6
Evalue of construction is 2500 or more,a RECORDED Notice of Commencement is required.
S�IJl�RHEIUIENTRLCC?NSTRt,�CTIDN LI'E.N LAUU IN, O'RI1lIATl®�hl.:
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 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
commencing work or recording our Notice of Commencement.
B
Signature of O er/Lessee/Contrac6Us Agent for Owner Signature of C tractor/License Ho
STATE OF FLORIDA STATE OF F A
COUNTY OF 5-V. L %Y, N� COUNTY OF L-��e
The forgoing instrument was acknowledged before me The f rgoing instrument was acknowledged before me
this C\ day of �V In sZ 2011 by this day of �yv�-� 20Al by
(Name person acknowledging) (Name of person acknowledging)
(Signature of Notary P blic-State of Florida ) (Signature of Notary ublic-State of Florida)
Personally Known OR Produced Ide Personally Know
Type of Identificatio IEGNENS Type of Identific o��.pV;U•. DEANNA MARIE GIVENS
Produced �. DGANNAMAR Produced ' MYcoMMISSION#GG022023 I
gip' ION#GG 022023
a� :? pacember 16.2020 :y; ;o;%n EXPIRES:December 16,2020
XPIRES: is UndelwTIters " — ed Thru Notary P lic derwriters
Commission No. edlhnrNot '�p Commission No.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014