HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:—/ ECE
— _
Building Permit Application JUN 2 7 2017
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fori Pierce.FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Residential
PERM17APPLI'CATION FOR: 6�' y��-er-
ioma '+ _'
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Address:
J
Legal Description:
Property Tax ID#: Z�3 3 - 50 2= 06" 0 0 U ' Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Z6,49-1--C_e.- G16 �./o �.s v- -4-cr /-,r �r
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Additional Work to be ertormed un er t is permit-check all that appy:
_NA-echanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric = Plumbing _Sprinklers _Generator Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ J d U Utilities: Sewer _Septic building Height:
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Name T6 1-re Name rz-,S A 5t)'�
Address: Company: 64-1-5 1e4p1_cr- ��1.^S®✓`
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City: ��• A Ce— State:fj Address: /70) S '� � S
Zip Code: 3`1 Fax: City: )rl 111;14�c State:
_Phone No. !W- '7 T 0 5 3 Zi.p_Code: `7 Fax:
E-Mail: Phone NC(?7-Z:) �o 1 36'7 3
Fill in fee simple Title Holder on next page ( if different E-Mail
from the Owner listed above) State or County License et S
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not"pplicab I le
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE FOLDER: _ Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OVtrNER/ 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 wqek or recording
our Notice of Commencement.
Signature of Owner/Agent/Lessee/Contractor Signature of Contractor/License older
STATE OF FLORID ~N _ STATE OF FLORID w
COUNTY OF a�� I COUNTY OF
The forgoing inst ent was cl;nowledged.b � W z The f rgoing instr ent was cknowleciged before me
this day of2017 o�� e this day of 20by
L7
�W o �ruxi
Name of erson wled ing) (Name of person ackn wle in '`'
I P1 )I JA1% -6� �&I -A
(Signature of Not 9
Puic-State of Florida ) (Signature of N tar Public-State of Florida )
/b
Personally Known/ OR Produced Identification Personally Known '� OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission No. (seal) "Commission No. (Sea[)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW-- REVIEW- REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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