HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: 61 tc d I n-°a
ECEVVE
Building Permit Application JUN 13 2017
Planning and Development Services
Building and Code Regulation Division r
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
PFQOSI D IN1R01lEMENT[.C}CATIO
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Address: / 4-1? eCtSf :-li k (-Ou,
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Legal Description:_ T , E 67Cik Sq i �VOC4 C U,_1-'T J , A e Cc*Awg It-0 `/
Pl.►-r //cam►;��,,� Arm.,-ek 11. l%
Property Tax ID#: 3 0-Jq (Ocro ' q Lot No. t
Site Plan Name: Block No.
Project Name: :57Vc c_p //VI.�o20 ✓ �
Setbacks Front Back: Right Side: Left Side:
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DETAILED DESCR)PT1'0N 61 QRK £
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CtNSTRUCT)O`N NFORMATICN �_ . ., �zu .,...'
Additional work toe e ormeL under tispermit–c ec a appy: LJ
HVAC 11 Gas Tank E]Gas Piping _Shutters Windows/Doors
Electric ❑ Plumbing Sprinklers 11 Generator E] Roof Roof pitch
Total Sq. Ft of Construction: Scl. Ft. of First Floor:
Cost of Construction:$ A j50-0 Utilities: Sewer Septic Building Height:
Os Nt AAESE 1 . .� �� r`3
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Name `JvOL)s ,oppOff X/✓c Name: 30,W%k,15 V\ V & A �'h.
Address: f y �6 ��L ' • /-/ Company: r)W oryx 9(01 QiO' IVIG•
City: Of yto State: FC Address: --I --2330 SE 01" l�f� SUL'�' �S
Zip Code: F_s�Y4—� Fax: City: i4y_S0tAn!_ State:
Phone No. (7 f—3Z2 1—G 2 Zip Code: 33t155 Fax:
E-Mail: Vao4> bLi /0 42 6)n^r 'St 11"T Phone No. 60.31 06 5-1
Fill in fee simple Title Holder on next page(if different E-Mail: fth(JrAl5+o(nrl NVIR
O from the Owner listed above) State or County License: �cJ
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CflNSTRUGTIQN LIEN LAIN lNFORMATltN:ff $'
f � �
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: - State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE BOLDER: _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 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 o attorney before
commencing w.oQ&r recording our Notice of Commencement.19
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ignature of Own er/Lessee/Contractoroas»/gen forOw_ ne? Signa re of Contract icense Holder
STATE OF FLORIDV L • S ATE OF FLO A
COUNTY OF JJ vG�Q COUNTY OF
The for oing instrument was acknowledged before me The forgoing instru ent was acknowledged efore me
this / day of Uva 20 iY by this day of 20 by
;,� o Jc cam. U G41
(N f IreKscEnfAnowledging) (Name of person acknowledging)
&Pfffure ary Public-State of Florida) (Signature of N&Iry :��:ocluced
a of Florida )
Personally Known OR P oduced Identification � Personally Known Ident'fi n
Type of Identification Produced \\\��IF��49�
Type of Identification Produced �(i ✓GfS �,�Gen,fe YP
Commission No. OW 01960/ (Seal) Commission No. STA 1,`�cP���
45N Notary Public State lorida 'Comm.Expires
an Jones No.FF0636 "
Revised 07/15/2014 y, My Commission GG 018601
alp,Add Expires 08104/2020
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DATE
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