HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE II/NFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED !�
Date: / / Permit Number:
Building Permit Ap0`4_,icati&
Planning and Development Services JUL ' 9 2017
Building and Code Regulation Division JUL a i 291?
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial erdrltlal V
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
SEDC hIVIPR VEMIEN_T LO`.CATY c N .x _ _ n
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Address: 7 O— /U W�� M( kmy - -
Legal Description: aot"Ao 41� / /rC•G//T .� /() �S
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Property Tax ID#: ggo9 3 7O/ 0 40 9 Dob 6 Lot No.
Site Plan Name: #QO 1604, ( Block No.
Project Name:
Setbacks Front Bac( Right Side: Left Side:
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CCINSTRUCTION INF®R
Additionalwork to be nertormed under this permit—check a appy:
❑HVAC Gas Tank Gas Piping MGenerator
Shutters Windows Doors
Electric F-1Plumbing Sprinklers Roof Roof pitch
Total Sq. Ft of Construction: c Sq. Ft.of First Floor:
Cost of Construction:$ 3/1 Utilities: Sewer Septic Building Height:
Name_ Name:
Addr : !?iG� ill i&') KK��Y(',y-02=V_ Company:(' '
City: AState: Address:
Zip Code: Fax: City: p� St�aterr
Phone N t q(� - Gj2q --\ D(21- Zip Code: �j�L i Fax: ,�(p� — L -c
E-Mail:
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Fill in fee simple Title Holder on next page(if different E-Mail: J�(\AQ I wkk�� .COPY)
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
S FPLE 't ENTAL CON�STRUCTIO'N$LIENI LAUWI,N"FORMATIQ'N`:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLEHOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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 insp3.ction. If you intend to obtain financing, consult with lender or an attorney before
commencing wg;k6rAcording your Notice of Commencement.
S
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF COUNTY OF
STATE OF FLORID
�yjj �.,ti COUNTY OF �
The forgoing instru entras acknowledged before me The forgoing instrument was acknowledged before me
this 7 day of L 20 Oby this 17 day of 1,tj 1 L,4 20 _LY by
arr) wr'' +
lc� A r lraz &2i
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Nota4lf ublic-State of Florida) (Signature of trotary Public-State of Florida)
Type of Identification Pro ;d �c.: miss on#GG 067945 Type of Identification Prod ctd"'�';
Personally Known OIC _ fyt�ed NEVILLEfFlorida Personal) Known
KARI NEVILLE
My Comm.ExpiresJul NotaryPublic-StateofFlorida
%9j�uFiS;o° p ughNalianalNotaryAssn. 3 t�i[lion#GG 087945
Commission No. Commission No. 9* n M o Axpires Jul 22,2021
Bondedthrough National Notary Assn.
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS