HomeMy WebLinkAboutBuilding Permit Application "From:.Bailey Whittemore Fax:(800)767-0066 To: Fax: (772)462-1578 Page 3 of 5 0810912017 1:57 PM
ALL APPLICIBLE INFd LIST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date:
Permit Number: 1l XU
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Planning and Development I Services Building Permit Application AUG 11 9 2 011
Building and Code Regulation Division PERI'
r 2900 Virginia Avenue,Fort Pierce FL 34982 nt
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Res l"Sh 4-i";9V y, FL
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PERMIT APPLICATION FOR: To Select from dropbox,click arrow at the end of fin
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Address: t. Lca Un �hr
Legal De ription:
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'FT.n .-L+!
Property Tax ID it: C-1 CX-1 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side., Left Side:
2
VW&C, C C\ (>C-
L TT_i 177
Electric 1:1 Plumbing FISprinklers Generator Roof Roof pitch
Total Sq.Ft of Construction: S, Ft-of First Floor:
Cost of Construction: Utilities:( Sewer
Sewer Septic Building Height:
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Naz 1, MC Name:
Address:d SS: t71CJ
n22 0-4\a, I Company
State: Address: LA
Cit (>rf-pf�bm H
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; Zip Code:-.,_5 (V _� Fax City:'t rA-V
Mf� — La state
Phone No. _26 Zip Cod 12,
Fax:
E-Mail: Phone.No.
Fill in fee simple Title Holder on next page(if different E-Mail:
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from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
From:Bailey Whittemore Fax:(800)757-0066 To: Fax: (772)462-1578 Page 4 of 5 08/09/2017 1:57 PM
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY- Not Applicable R
Name: Name:
Address: Address: )
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applicable 3
Name: Name: J
j Address: Address:
City: City:
Zip: Phone: Zip: _ Phone:
---- —.......... ..
OWNERf CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the workand Installation as indicated.
1 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
comm.efyAngwor or rQcording Your Notice of Commencement.
Signalure of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Halder
i
STATE OF FLORIDA STATE OF FLORIDA I
COUNTY OF COUNTY OF
The f. rgoing Inst me it was acknowledged before me The forgoing insof . ent was acknowledged before me
this day of 20�by ;this' day of 20AA by
g.
Name of per on aking statement Name of pe�{onn rn king statement
PersonallylCnown OR Produced Identification Personally Known iC OR Produced Identification j
Type of Identificah"on'' Type of Identification—moi
Produced Produced
(Signature of Notary Public-State of Florida) i (Signature of Notary Public-State of Florida)
Commission No. Commissi
wr:laaF,` OONNAM.HILL rt,;°EarEs, DONNAM.141E
T� ! iq.AhVCOMi`dISSION&00099038 (;i.,: �,'. MY COMMI.S610Ni{GG09�038
E,YPIft Af>N 3D;20?.1 _
.i`°lid': t`,..euh6c Undetittlle^:
REVIEW..`E;;;sf Mu I PERVI$OR PLAN$ – MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED _
DATE
COMPLETED
Rev,8/2/17