HomeMy WebLinkAboutBuilding Permit Application All APPLICABLEINFOMUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �G
Date: 0' U Permit Number: //7 pw, , r
IIIIIIIIIIIIIIIIIIIIIIFF Building Permit Application AUG,/ 7 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: ,
PRO�PaSED INPR®UEM�ENl" LDCATI'0N:
Address: 3� �TL, �'!`1c �K U3`�gla �P
Legal Description:
Property Tax ID#: Co '— O a s- add `- Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILEION 0
=C$@NSTRX'C6TwI'19N,'1I;N.'1FQR!MATI;ON:
Additional work to be performed under this permit-check all that appy:
_Mechanical _Gas Tank —Gas Piping _Shutters _Windows/Doors
_Electric Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq.Tt of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ S • Co Utilities: —Sewer —Septic Building Height:
OWNER/LE=�StiSEE: CQNTR�IC�! (3R:
Name C14 gR Name: /J S 7Z�
Address:�3 del QTL, (2.f1L 14j 81w). Company: t P-A S , C ::- C00� ,
City: ' �': State:\� Address: 3 \4 JI-) AJ "E�7
Zip Code: 7"\9L< l0 Fax: City: _ �- — State
Phone No. '?'I -- S g,- + Z SCS Zip Code-5`-1 Fax:
E-Mail: Phone No `I�1 ),- SYS S LP
Fill in fee simple Title Holder on next page( if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
StJ`PPLEI�IENTAL CONSTR+U`CTIaN L.I�E LA11V I�Ni�®RI�IAl"IOtU:
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:
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 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 Commenceme ust be recorded and posted on the jobsite
efo first inspection. If you intend to obtain finar Ir , con It with lender or an attorney before
c enci rk or recordingour Notice of Comme e 'rent.
Signature of Owner/Lessee/Contractor as ent for Owner SiNature of Contractor/License Holder
!U N a
STATE OF FLORIDA STATE OF FLORIDA _�
COUNTY OF COUNTY OF x m a
aj&3:5-:
I w�� w Luz .p
The forgoing instru nt was acknowledged befo . l The for ing instru ent was acknowledged before m r,oa
this day of 20��by z` .g this da 20�by aw
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(Name of person acknowledging (Name of person acknowledging) Em