HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST.BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Q�O�)? Permit Number:
. 1
1' ZEN
_r Building Permit Application JUL 2 5 2017
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:
_21—
Address:.: Af '13 pf� .r �lc
Legal Description:
Property Tax ID#: 4 - (21 23 V - Q Q 0:2. Lot No..
Site Plan Name:. Block No.
Project Name: Me I tS i ) 0'.-
Setbacks
0'.-Setbacks Front Back: Right Side: Left Side:
t� St
Additional rk to be
pertormed under this permit--cneCK all that appy:
Mechanical Gas Tank as.Piping _Shutters Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: •q
S Ft.of First'Floor: -
Cost of Construction:$ f2 J,' Utilities: _Sewer _Septic Building Height:
Name ' Name: O 7' l
Address: 3� S' Company:
City: �.�IaZL� �� ��(0 �T t Z Z
stat Addressl1•, _�� s d S� �
Zip Code: Fax: City:)fA,t � J/ State
Phone No. `7'72. 33'A 7 9 Zip Code: ;�LVQ_83 Fax:
E-Mail: Phone No :1-7?./
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License Kip,- I J�0�.5 Paco
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: . _Not Applicable7Na
AGE COMPANY: Not Applicable
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 concurrencyreview: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.
;_nkture of wner/.Les ontractor as Agent fo Ow�nerE, Signature of Contra r/license Hol r �.
y v'_. C• W T o
STATE OF FLORIDA - U!U3 STATE OF FLOR - ���,�
COUNTY OFA. COUNTY OF2-5
a o
The f ing ins ent was acknowledge Mefore W V6 l The fQr�g�oing ins nt was.acknowledge 4efore j¢ 2
thisday of 20 by oX a this day of 20_ by ¢gX
�W �W
oe
11 i ,L,�r� *:rom 1
(Name of pers6 acknowledgi g) z ;o (Name of persona nowledging)
Aldo
(Signatur f Notary Public-State of Ylorida) (Signature of Nq � Public-State of Florida
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW.
DATE
RECEIVED
DATE
COMPLETED
ev. ILUI