HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Q
Date: Permit Number:
RECEI 7D Ml 2 8 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 Residential
PERMIT APPLICATION FOR:
PRQP®.SED IN,RR��UEM,_ENT L�CATIQN:
Address: -M D I'C XuJ 566) 1 Z-22AG 192127__SZLOUC= 31496 YD-
Legal Description: k6--PLA'7- ax L()T 3 3
Property Tax ID#: 3L IS— -7oL9000q— oQua Lot No.
Site Plan Name: -,.�1 �jitl C—S Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION QF V1l®RK.
f�&_PL ACM C-_vJT of I J MAPA IBJ S &aN S L 1b I N 69 6 LAS S t7(yg_S GJ I T7f
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KAM -111 No aw
311100 MOM
C®NSTI=ION 1�N!FORMAT10,N:
Additional work to be performed 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:
Cost of Construction: $ ,�L:�,600 0 U Utilities: —Sewer —Septic Building Height:
O'1!1!'N ER/LE=.SSE�E C®NT'RA�C�iTOR: `
Name Name: (Z6RF2eT Sf}i✓i��VD/i b)>fl�
Address: 6:1 qq 1)1 Ckl A�6d I C- a• Company: S'Aluco C� STI�UL71G1� C`ti�
City:ega CA Stater Address: I l a'� A)�E Q V PN' ?L.,
Zip Code: S2 Fax: City:;TC-�S / QC�9C1-1 State: 1:-L
Phone No. Zip Code: 34851 Fax:
E-Mail: Phone No /.S
Fill in fee simple Title Holder on next page(if different E-Mail AD L, Co M
from the Owner listed above) State or County License r'�C 0 b/yd 3
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL C®NSl"Ft+t,1CTl®N LIEf� IAUU 1eNQRM�►TtON:
DESIGNER/ENGINEER: _,zNot Applicable MORTGAGE COMPANY:
Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: _,ZIVot Applicable BONDING COMPANY: _zKot 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 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 orapaLttorney before
comMeneing work or reco6Rffg_Wur Notice of Commence
Sig ature of Owner/Lessee/Contactor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 5�. COUNTY OF '*1 Ltic•��
The forgoing instrument was acknowledged before me The for oing instrument was acknowledged before me
this!` day of 20 0 by this a. day of5 O V-C 20-a by
�6�0cr -c SA--NAitC\ C% ate
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary blit-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification_
Type of Ident'fication Type of Identificati ---
YP — i
Produced t+ 9 L ��--�-� GNENS " Produced �t- �'"p�'*a DEANNA�tF,S2IEGiVEN5 a
C:ANNAt,JP 2iE „ . �. 111.11—ION#GG 022023
b4Y COM+tlSoiON#GG 022023
••'`�Y"Cel;:- t " ��' `�' �_' EXPIRE=S:December l6,2020
Commission No. 4 =' :�: E(��� Drcember16,2020 Commission No. �t
�d.,ziters 'S� o �B ded Thru Nota(�e3{)Undervniters
d Thru iwta y Public t
Bonds -
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014