HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
�i�V
�I E I ISD JUL 1-8 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:
Address: 01 R7.9 0 6 L L Ul - 1' e r &e
Legal Description:,
Property Tax ID#: 1301- Zd~�Oce�a-oC�o-� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side. Left Side:
G lf N Lp&rvt c-e amp b 0Yl/L r'(.,;,Osfrls
,� 1014e
Idditionalworktobeperformed under this permit-check ail tat apply:
Mechanical _Gas Wank T Gas Piping —,Shutters Windows/Doors
L/ Electric _Plumbing ,Sprinklers _ Generator Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ /P0LQrL,7a,-ts Utilities: Sewer _Septic Building Height:
i
Name Name: : r
Address: v a` C U- Company:_�,, 5'
City: State:� Address: 11 �U r-�7a�`�/'jr/ '
Zip Code: Fax: City: Stater-
Phone No. 77Z. — 33 Z—rGJ Zip Code: c�r���4 Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License_ e G
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
commencing work or recording our.Notice of Commencement.
Signature Owner/Lessee/Contractor as Agent for Owner Signa re Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF SaCOUNTY OF ��'• Lyc'�
The fofgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 5 1y ,20 by this _ day of Jy�J. ,20�7 by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary P lic-State of Florida) (Signature of Notary Pu lic-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identific ,
Produced Produced DEAN NA MARIE GIVENS
MY COMMISSION#GG 022023 z
••"+P�"••,,
DEANNA MARIE GIVENS
i o PIRES:Dery 2020
Commission No: MY ION#GG 022023 Commission No.
"
EXPIRES:D�ecemberl6,2020 Thru Nota c derwriter.
o,-
�'•koF F 0 Bonded Thru Notary Public Underwriter
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW - REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.7/2014