HomeMy WebLinkAbout06-20-2017 STAFFORD PERMIT APPALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
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: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: ,T q `' J IV�4149 �
Legal Description:_Vwcy bW_1 L_ (LAI- !%J
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Property Tax ID #: - C)00,:K ' o Lot No.
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Site Plan Name: 56 Arr 1) Block No.
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Project Name:-
Setbacks Front Back: —i.— Right Side: Left Side: -,
_DETAILED DESCRIPTION OF WORK:�yv
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I CONSTRUCTION INFORMATION:
AUJiti na wor to e e orme ,in- er tFii permit - check a app - -
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HVAC Gas Tank 0Gas Piping_ Shutters Windows/Doors
11Electric 11PlumbingSprinklers ❑ Generator ❑ Roof
'Total Sq. Ft of Construction: Sq.of First Floor:
Ll
Cost of Construction: $ Utilities: uSewer Septic Building Height: �Y
OWNER/LESSEE:
Name J
Name:
Company: ,
Address- 1 ��
City: e: YJLV_
ddress:
Zip Code: Fax:
City: State:�-
Phone No.
Zip Code: Fa :
Phone No. - e
E-Mail:
Fill in fee simple Title Holder on next page ( if different
E-Mail:
-From the Owner listed above)
State or County License: l
If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:,
DESIGNER/ENGINEER: Not Applicable
Name:_
_
MORTGAGE COMPANY: _ Not Applicabk
Name:
Address:
Address: _
City: State:�_
Zip: Phone: _
City: State: _
Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable
Name:
BONDING COMPANY: Not Applicable
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 o your)property. A Notice of Commencement must be recorded and posted on the jobsite
befree-the first ins Af you intend to obtain financing, consult with lender or an attorney before
commetn rc o2�rrrik yquir Notice of Commencement.
_ Signature of OW—her/ Le e6/Agent
STATE OF FLCQ
COUNTY OF Vf%;"M--m
The forge ing instruml� i@nt as acknowledged efore me
this ay of 1V 0 l
(Signature of Notary Public- State of Florida ) (�)
Personally Known OR Produced Identification LJ
Type of Identification Produced \_-1 C!=Ia. Q
Signature of Contractor/I:.cense
STATE OF FL
COUNTY OF ( __
The forgoing insqurnent was acknowledged bef re me
this U day o Q 20 "'"y
(Na
(!%nature of Notary -Public- State of Florida )
Personally Known & OR Produced I
Type of Identification Produced
HE _ MY COM WI F 036576
Commission No. E % Commission No.
EXPIRES: July 21, 2017
Revised 07/15/2014
/�. �F�j(��LEN DOWNING
11M�JP)hAMISSION # FF 036576
EXPIRES: July 21, 2017
Bonded Thru Notary Public Underwrite s
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW,
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
COMPLETE
INITIALS