HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: <t Permit Number: �1 �� dvroC)
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REM'.' D AUG 0 82017
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,IIVIPROVEI. 'ENT'LOCATION:
Address: 97t 'Q_k\,J T-4 nrc-L
Legal Description:
Property Tax ID#: 3�c��,J �id�-Z�yLot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
v
DETAILED DESCRIPTION OF WORK:
kA Af6i Am(�'�S��v IGS -To 200'A01\P 5e_(wL
/50Ame Qf 40c,\LeIL PPCt-�!F-L- V, (-I
1 V&_NAL. (S I A 1 1,4 L.U)Jq
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CONSTRUCTION INFORMATION
Additional work to be nertormed under this permit-check all that appy:
HVAC Gas Tank Gas Piping _Shutters ❑Windows/Doors
Electric ❑ Plumbing []Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction:$ GOO • 0 V Utilities:n Sewer Septic Building Height:
Q1N:N,ER/LESSEE :,: ' CONTRACTOR:`'
Name . G� �"' : Name: ,. �0. L2��
Address: -S' ? UA) S£ (, Vd Company:_ 4V LW "a- &_4 N 6 C LG
City: T-�- Cifrnt - State: FL Address: ' ( L" Owe-
Zip Code: Fax: City: Lt,GGf State:�L
Phone No. Zip Code: 3Lt, S2 Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: ISO L-tomfrom the the Owner listed above) State or County License: l�G 1 300 12 7S
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CON STRUCTIOU.LIEN L'AW INFORMATION.
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:
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 thepermit 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 'rst inspecti I I. If you intend to obtain financing, consult with lender or an attorney before
commengfrig work or C'Ording your Notice of Commencement.
J&�_ s
Signat e nerjte.AeelContractor as Agent for Owner SignaturJFLORIDA"6-or/Lit se older
STATE OF FLORIDA STATE
COUNTY OF_f�. Lyc1 COUNTY OF
The fotgoing instrument was acknowledgjd before me Theforgoing instrument was acknowledged before me
this�day of a.�c� 20 Lby this_day of 6-k-4 20 -D__by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pub' State of Florida) (Signature of Notary Publi State of Florida)
Personally Known OR Produced Identification Personally Knownogjg�l€iit
Type of Identification Produced S 1 Type of Identificat n ". °d[eQd MI{�I�>3#GGo^
=a
A pR1EGNEN 023 .'�" EXPIRES:Dere UeGUnderwasrs!"
Commission No. MYC���ION r�6 02p Commission No. dedThNNO
::°�' ��, EXPIRES:DeCepublicUnden+vdte�s
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Revised 07/15/201
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW' REVIEW
DATE
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