HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
���7 6'r'(J JUL 1 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:1 '1-v**1 ,61
r
' - 7d
Address: 1 S J� A'� Q/ S T
-Legal Description:
Property Tax ID#: 6 7 — C>/ 2�(D - UOU Lot No.
Site Plan Name: Block No..
Project Name:
Setbacks Front Back: Right Side: Left Side:
itiona wor to a
pertormed un er t is 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:.$ Oo C)GJtilities: _Sewer —Septic Building Height:
Name--
LAP/1'19S Name: 'Is
Address: oU y%W 6SCe��v �N Company:� W��Sv^� �5 LLC
City: State:4-1 Address:
Zip Code: 3Y-�1 'Z Fax: City: !'-e,2!-e State:,
Phone No. 772-' 2�0 c/_yY Oy Zip Code:,35 9 oZ Fax:
E-Mail: Phone No -7?-2- 20-7-62(-t P O
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or county License
If value of construction Is 2500 or more,a RECORDED Notice of Commencement is required.
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:
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 or an attorney before
commencin work or recerftg yourrecd Notice of Commencement.
Signa re of Owner/Les 'e/Contractor as Agent for Owner Signature of Contractor/ cense Holder
STATE OF FLORIDA STATE OF FLORJNA
COUNTY OF Sk. L��cc COUNTY OF 77
The forgoing instrument was acknowled ed before me The forgoing instrument was acknowledged before me
this` day of 16 ly ,20AI by this day of .S J NV ,20]J by
��ornaS �acabSo,r� ��n,oVY•gS o 'Oslo VN.
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pu c-State of Florida) (Signature of Notary Pu lic-State of Florida)
Personally Known T OR Produced Id jPersonally Known OR Produced Identification
Type of Identification Yo, DEANNAMARIEGIVENS Type of Identificat
•��_� II'roduced DEANNAMARIE GIVENS
Produced Y COMPAISSION#GG 022023
EXPIRES:December 16,2020 1 c r ,rye; MISSION#GG 022023
P= r � WNotary Pub{ictlnderwriiers 4 ommission No. "�' •• s 1 SPIRES Dec 2020
Commission No. 6 F Bo,,�� li— J o WdThruNota u is nCenvrit9rs'
_i
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 112014