HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: l(� l ' I� Permit Number: lJ
Building Permit Application
JUS12 2017Planning and Development Services .
Building and Code Regulation Division F EF,ffil��l"Ifs G
2300 Virginia Avenue,Fort Pierce FL 34982 St. Lucie unto-, FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: Window/door
� OPOSEO 9iCVEtViEE1 LQCAT� I. . .... ...
Address. . _+ -} 3e_eepbai.�Ye Gly
Legal Description: �o7 I� PuD1L S(Lteef 13 2` Iii i
Property Tax ID#. 3 Z2 -4-00 OQQ CC20 Lot No.3
Site Plan Name: V-0614 Block No.
Project Name: I'-oGtk
Setbacks Front Back: Right Side: Left Side:
3R;•' F F N
f TAIL L DESCRIPTION"' F Vt o
4'FLAC6- i moV_
CQNSTRUCTI{ N ttF0R11ATION
Additional wor(tote ertorme un er t is permit-c eck all appy:
HVAC Gas Tank E]Gas Piping _Shutters' Windows/Doors
11 Electric ❑ PlumbingSprinklers Generator Roof
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ 61CDD Utilities:cn Sewer Septic Building Height:
Name fz ►J t�,�- -Pv>2-. h AvO Name: wAKNt T Ho"A 5 ByRI JE 1 1 i
Address: �i�3 `3 t�f�12,EK G�2 Company: TU,0-1QA- iVor-A� (u-i?go-JE
t-�Nr
City: pT ST_ Lu�.r L% State:f L Address: 3c4 Ll 5>v-3 42.1-id !�Frg-fE-r
Zip Code: Fax: City: NuLOf v.,00n State: T-L
Phone No. '-Ta<% 31 3 6 i 39 Zip Code: '33:3)2 Fax:
E-Mail: Phone No.154 +97- 9415
Fill in fee simple Title Holder on next page if different E-Mail:
from the Owner listed above) State or County License: CSG A- ot,IS qe
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
StJP.PLEMEi*1TAL CONSTRUCTIGON L10 LAW INFORMATION
:.
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: �L_ Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: k 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.
Sig ure of Owner/Agent/Lessee Sign e o tractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 4f tv-6N-e COUNTY OF 130-_�CA
The forgoing instrurnen/t was acknowledged before me The forgoing instrument was acknowledged before me
this T Iday of } 20Q by this to day of \O&c 200 by
(Z-C%e,C 00vrV%,,W WA`(P'� �iFou—�y1 � �yJL��ETT
(Name of person acknowledgin (Name of person'acknowledging)
(Signature of Notary Public-State of Florida) (Signature 4 Notary Public-Stie of Florida)
Persona lyfb pgA"IqAica ion Personally Known OR Produced Identification
Type of nti atirn P�ifSSiBRt-#FF69326
Type of Identification Produced
- �i11p���M1)T1J
'9�F 'F"OQ;.•` EXPIRES July 2.2 17l}
Commis i4o7)s3 8U or a osaryser�ice.comCommission No. (Seal) � QVµ 29g5
7.
0 X411
Revised 07/15/2014 EXPIRES
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE -- —�—
RECEIVED I
DATE
COMPLETED _ ��`