HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED a
Date: Permit Number: 316-t- (011--\l
, == RECEIV-:D AUG 0 9 2017
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: AMn-dew/door /( a4AC 6tt Do,op-,
PROPOSED&fM"PROUEME.NT"LOCATIN ° 4',
Address: V157-14 L VD
Legal Description: �i��� PAli?X QAIIT- §-
Property Tax ID#: — ® � o — 0 Lot No.
Site Plan Name: Block No.
Project Name: C60& C7�C
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK. :` .
_co� Ate-". R/Ai-f) -DAA'b& CD N � �' �
"CONSTRUCTION INFORIVIATIO�N :� ' ,�"
Additional work toe e orme under t is permit-check a appy: e�?4_(�lt A6 6--HVAC E]Gas Tank ❑Gas Piping Shutters ndo Doors
Electric 0 Plumbing ❑Sprinklers ❑Generator ❑ Roof
Total Sq. Ft of Construction: J(y S . Ft. of First Floor:
Cost of Construction:$ �''— LitilitiesInSewer❑Septic Building Height:
OWNER/LESSEE CONTRACTOR:
. .
Name D �`�— COOK, Name: . "'(S 01Y-A
Add r s-,Q5 ���11 J CA-"(O G�D Company�uc--7p �(l_
City:#71-S7--LAG/C Stater Addre :
Zip Code S3 Fax: City: 01 H 6O -VJ6 C.J QSt`a/te:F/
Phone No. -772 1 — g3b Zip Code:3-3ff/� Fax: W.-2
E-Mail: tf/ice Phone No.;/45 /_C_/ �,Jl��d
Fill in fee simple Title Holder on next page(if different E-Mail:;�7� 1.1'_.�//CL/��r — �C-�� ry�
/
from the Owner listed above) State or County License: C A, C— 0-3 3 13 '
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SIJPP"LE MENTALCONSTRUCTIO -LIEN LAW INFORMATION::°r
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: tate:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: YNot 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 inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording our Ngfice of commencement.
s
ignature of Owner/Lessee/Agent natu o Factor/License Holder
STATE OF FLORID STATE OF FLORID
COUNTY OF 1 ��,.ss�� COUNTY OF � '�
g*�%_X3CX
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of
c..a Ti� 201�by this day of uc v 20 i by
e�oU '�LL� N 15J�5 J&4
(Name of perso .aeknowle ring) (Name of person a WILs 1
_'(Sig. ture of N ry P - rida) (Sig ture of Not Publa rida)
/ersonallynw �_OR Produced Identification ersonally Kno n PPod�'
Type of Ide ification Pro Type of Ident• ication Pr ce
HENRY RAMIREZ
.`'_ v P •°= ISSION ii FF 102369 =:"�Y P� MY C IiE_ liAMIREZ 02369
Commission No. t: MM Commission No. __
A. ° PIREES:March 16,2018 '-�'. a EXPIRES:March 16,2018
Bonded Thru Notary Public Underwriters .;or.'„°.•` Bonded Thru Notaiy Public Underwriters
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS