HomeMy WebLinkAboutBuilding permit application 07/07/2017 06:50 772-567-5290 JIM RDTT. HOME IMP AC PAGE 02
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED V
Date: Permit Permit Number:
Building Permit (Application JUL
Planning and Development Services
Building and Code Regulation Division FEES 1Ii61 �irsG M
2300.VirginlaAvenue,Fort Pierce FL 34982 St. Lucia 0oL nt,,. FL
Phone:(772)462-1553 Fax: (772)462-1578 Commercial � Residential V _
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
P110POS. :,C P`'R 1 IVI-ENT LOCATION:
Address: �Q
Legal Description:
Property Tax 1D#: M o �'' C5 1C)n Lot No.�, �',�,__
Site Plan Name: Art-I . 6 a 6 e.V- Block No_
Project Name:
Setbacks Front _ Back: ,,, __Right Side: Left Side:
DETAILED' 30Ca1:PTIGN OF WORK
( f lox e ex►5"h r.L p, 0', s-- C 0 r N j 14,
�0�- RAXT1ON INFORMATION:
AC10itionatwork-to7UL-nertormeiI under this perms -c ec a app y:
FI
HVAC Gas Tank Gas Piping _Shutters Windows/Doors
13Electric Plumbing OSprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq.Ft,of First Floor:
Cost of Construction:$ LQ _ Utilities; Sewer 0 Septic Building Height:
C7W- K—P4A;; SS-E'E: `
Name Name_ r
Address: C`5 Company:
Ci , P State: ,. Address: t-d.
-e i a Cc:-&
zip Code:It V 41-TI Fax: City:Vz("0 a„/,,.C, Stater
Phone No. 1`71 � 47 S�D C) Zip Code: .) el Fax:-)M
E-Mail: Phone No, _2 �
Fill in fee simple Title Holder on next page(if different E-Mail:� iy�► @ ;
from the Owner listed above) . State or County License: ��,[ 0.-s-R i2��
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
07/07/2017 06:50 772-567-5290 JIM ROTT HOME IMP AC PAGE 03
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DESIGNER ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ _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.
5t,Lucie Count 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,l 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.
Signature of Own Lessee/Contractor as Agent for Owner Signature of Cont for/License Holder
STATE OF FLORIDA STATE OF FLORIDA_
COUNTY OF 1ndi& 1 1iQE COUNTY OF I Y)eJ IGUII�„Q `�lY
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of -Ti 1__ _ zo j by this day of `b L�L ,20 L—by
�&CV�A 'la'WIS auft
(Name of person acknowledging) (Name of person acknowledging)
M
(Sig a re of N tary Public-State of Florida) (Sin ture 004otary Public-State of Florida}
Personally Known . OR Produced Identification Personally Known_ OR Produced Identification
Type of Identification Produced Type of identification Produced �—"--^
Commission No, fission No.
�" �Z ¢ �'�"" NOW Puknc sine of F . • ,�t�' NotaWq Pnb16D seas Of FWWE
. Jennifer M Rk�mmw f-2 �' Jennftr M RkWond
Revised 07/15/2014 w f"OIW2112019 obr2+�zota
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS