HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: (f' ��' � � Permit Number:-
Building Permit Application
Planning and Development Services JUN 2 3 2017
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial Re, idential_
PERMIT APPLICATION FOR: ; J
Address: 5121 3UN-N R-ek
Legal Description: 4 0 `a es_(t W
Property Tax ID #: gy 0-3— 6 n
Site Plan Name:
Project Name: Ilu ), c e
Setbacks Front Back:
QW
' zi i cl -7_ O Lr) CSL/•
Side:Right Side: Left
Lot No.
Block No.
Adaitional worK to oe pertormea unaer tnis permit- cnecK all tnat apply: t
_Mechanical _ Gas Tank _ Gas Piping _ Shutters V Windows/Doors
_ Electric _ Plumbing _ Sprinklers —Generator _ Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
j
Cost of Construction: $ 5D �`�-• Utilities: —Sewer _Septic Building Height:
OWNER/LE=�SSEE:
CO.N;TRAGTO:R:
Name SQ vn.k H(A Y)OL
Name:
Company:
Address:
City:
Zip Code:
Phone No
E -Mai
Si" a or County License
Address: 512k pua V GJ,
City: li�a-`y State: F(
Zip Code: 34892 Fax:
Phone No. R i 2 9 TO Ci
State:
Fax:
E-mail: Syn ynt ww c 1 glyna e . cz YY1
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
y'PPLEMENT�AWN,F®RMATION:
DESIGNER/ENGINEER: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name:
Address:
City:
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 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 C event must be recorded and posted on the jobsite
before the first inspection. If you intend to obt 10" n' ing, consult with lender or an attorney before
commencing work or recording your Notice ofu"xt;cement.
Sig6ature of Owner/ Lessee/Contractor as Agent for whi&2 v
gy
STATE OF FLORIDA poi
COUNTY OF c
Li The forgoing instr ent was cknowledged before
this day of 20�y
Scoando M&J al 0 n cul o
(Nam 61
person acknowledging )
(Signature o otary Public- State of Florida )
Personally Know OR Produced Identification
Type of Identifi -ation q
Produced
Commission No. (Seal)
Signature of Contractor/License Holder
STATE OF FLORIDA
COUNTY OF
The forgoing instrument was acknowledged before me
this day of . 20_ by
(Name of person acknowledging)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Type of Identification
Produced
Commission No.
(Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014