HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1��� ` �1 Permit Number:
RECER"D JUL 212017
x. 41� ., 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: � \—
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PROPOSED INPROVXq
EMENT LOCATION Ts L ,
Address: moi'
Legal Description:
Property Tax ID#: �� ��"1 al- ��d d J ad6 �d Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
QETAILED DESCRIPTION OF WORK. �; e iii �F�� � tit
CONSTRUCTION INFORmIR
11/IATION �� '
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Additional work to be pertormed under this permit ck 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: $ Utilities: —Sewer _Septic Building Height:
011VNERLESSEE �, CONTRACTORS � Ru -
_ . ..
tt� �
Name �7 `f �- :E Name:
Address: CSS✓,�;' l� a•e" 4q Compan i
City: r6r-4.1�� State:jL-L� Address: � G,?
Zip Code: � bFax: City: S �wi'� State: C
Phone No. t/r o Zip Code: Fax:
E-Mail: , a'/ (•C61-, Phone No
Fill in fee simple Title o) r on next page ( if different E-Mail
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from the Owner list bove) State or ounty License �� OOH- o -
If value of co truc ' is 2500 or more,a RECORDED Notice of Commencement is required.
! �� > )�:4CC�NSTRJTlON`LlEN LAW INFOFtMAT(ON. fl'
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DESIGNERjENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip' Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: T 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 1 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 ' NER:Your failure to Record a Notice of Commencement may result in your paying twice for
improveme s your property. A Notice of Commencement must be recorded and posted on the jobsite
before the irs Inspection. If you intend to obtain financing, consult with lender or an attorney befcaf
commen 'n ork or recordingour Notice of Commencement.
na of er/Lessee/Contractor as Agent for Owner Signature of Contractor/Lic nse Hol er
STA OF FLORIDA STATE OF FL I
COUNTY QF t-
k. COUNTY O
The forgoing instrument was acknowledged before me The forgoing-instrument was acknowledged before me
this day of I%S�) 2011 by this a) day of_ 20 Cl by
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(Name of person acknowledging) (Name of person acknowledging}
7
(Signature of Notary ublic-State of Florida} (Signature ofNotary blic-State of Florida}
Personally Known OR Produced Identification Personally Know �F11caPrii
Type of IdentificationType of Identifip DEANNAMARIEGIVENS
Produced — _ mycom,�iSS10N#GG 022.023
aduced -
DEANNAMARIE GIVENS i Ser 96,1112v k
'Q:PQ"'"G=, Cl =r• ded Thru Nota Public Undo niters i
Sry� F..o,. _l
�ry� '1 OMP,AISSION#GG 02202 I N
Commission No. LJ ��jj mmission No
(Sig
December 1n"",2020
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Bonded Thru NotaryPublicUnderweQnr
REVIEWS FRONT ZONING, SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
eV.