HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: \ �d1 1 \� Permit Number:
,., RECEIb1113 JUL 19 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: ZA
PROPOSED INPR0 4E'J*j'iT LOCATI0N:, s
Address: I U_Z W141 i� CAWJ—�:7 1 �iay— ee'-1006i: l%G 3�lS�
Legal Description:
Pro pertyTax ID#: 'S � ��� 13a^ 0bt'1-g46 "O Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
D"ETAILED DESCRIPTION 1C7FWRK �g�.
ia...li.e
CONSlCT ®N INFORil1/IATI`®N:
Additiona,l work to 6e-pe-rlo-rmed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ -���- QfJ Utilities: _Sewer _Septic Building Height:
®', N'ER/LESSEE: C®NT'RA ®,R:
Name t)�/3 Name: jel �r
Address: 1-3 2 141111165 &MAK IW,!F Company:_& u
City: 2i /C=yl CC-� State: Address: ��� SG �,�► 7%,iLf 1.U2
Zip Code: 3 Fax: City: State:&
Phone No. , Z2 ,3, Zip Code: 3 rr Fax:
E-Mail: Phone No 3 d)--
Fill in fee simple Title Holder on next page(if different E-Mail 'VaY/1) In
from the Owner listed- above) State or County License //_3 66 S9,5E
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
Sl1" PLEMRNT�I CONSTR=IJ�TtON l.tt`N LAW 1ENFO'RMATICI'N:
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 of Owner/Lessee/Contractor as Agent for Owner Signature of Contrac or/License Holder
STATE OF FLORIDAAf
STATE OF FLORIDA
COUNTY OF <:-;:7-r CG COUNTY OF
The for oing instrument pwsjacknowledged before me The forgoing instrument was acknowledged before me
this day of 20�0 by this day of, 20_ by
(Name of person a no ledging) (Name of Pers n a nowledging) .
(Signature of Notary P• lic State of Florida) (Signature of Not bli State of Florida )
J0. E FRESNILLO -' -
Personally Known < '����� yce Id ti Personall Known c� , roduced I
° ota � iTL�- te-0iFlncida y � �, e, 13tifiW RLL
Type of Identification =a¢ $°`- Commisslon'#FF 184850 ype of Identification ,tea°, g`� Notary Public-State of Florida
Produced ! :N o $er Comm.Expires Dec 22,201 roduced °_ Commission#FF 184850
BondedthroughNatlonalNotaryAssn ��••' My Comm.Expires Dec 22,2018
Commission No. Commission No. �� ondedsn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 4