HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �'�d� -6z-1 1
Date: 1 Permit Number:
RECEI\ -D 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:
PROP®SED INEPROVEIUIENl" L®0.01' nNI:
Address: ����� S(,G�s�� BI LId
Legal Description:
Property Tax ID#: J�jb-Z _IUGR" [�y�i� - C`��/j} Lot No. 3
Site Plan Name: Block No. 5 3
Project Name:
Setbacks Front Back: Right Side: Left Side: �• S"�
DETAFLED D'E�SCRaI'PTIQN OF 1NO:RSK:
o L -Z rc.4-cff - G IrtAA1(of- wZ ZU C tip - — 3o GV_1 WVc
C®'NSTRI)CTI® 0F®RWATI®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:$; _2L166. Ln C7 Utilities: —Sewer _Septic Building Height:
OWNER/LE--SSEE; C®NTRACT®R:
Name —1c t4 C'Y t31zI Name: tib-t-T-
Address: 630 Kvvu- 17r Company: PAYU,4 ELF
g:+-,C, LrLL
City: JQ ZSCee-6 drtVi- State:_ Address: -s/iz/ (fk4Sej Blvd
Zip Code: Fax: City: pwr-sl ;"yT l uGie Stater
Phone No. 20 e 29-03 Zip Code: 3(11 s z Fax: 772335/�3�
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail bob-1041 12-(P hge- -e74 .ruff
from the Owner listed above) State or County License &/,�Iz
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
S1IPPLEMEsNT#AL CC3NSTR!t1CTI®N 1.1E�N SAW IN'F®'R+I�II�,�IOt�I:
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 rk or recgj;ding your Notice of Commencement.
i C
i
Signat w r/Lessee/Contractor as Agent for Owner Signat Co-t ctc` icen a Holder
STATE OF FLORIDA STAT OF FLOR DA
COUNTY OF Sar. LUc0, COUNTY OF t>}
The forgoing instryent was acknowledged before me The forgoing instrument was acknowledged before me
this�day of U y ,20n by this�day of S% Ay. 20n— by
(Name of person acknowledgin ) (Name of person acknowl dging
(Signature of Notary lic-State of Florida) (Signature of Notary blic-State of Florida )
Personally Known OR Produced Id izn'" ` Personally Known OR Produced Identificat
Type of Produce Identification d VVD pR\E VG �o +% Type of Identification p NAMAR
NAS g22Cti� ItGVcN� G
. ..P.. , 1SSIONbei16.LQnp +iy Produced ro "r'P�• M JIISSIONbeG�22003 i
;� ...._ MFXp ecemubfw�nde�+r,1� : : 2.t.2
Commission No. ndedRhn(� Commission No. a°❑dedTbM i ,bf10U"ienvrSie 9t
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014