HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 'S�in � Permit Number:
RECEIVED AUG 14 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: To Select from dropbox, click arrow at the end of line
Address: 1i3? Se4u ConcZ _A ze-2- Plef/C�e- FL 3 G/!9F-2-
Legal Description:771 J ,Lri. ��Len 1 -03
Property Tax ID#: 3Ld///0' SUK- 03/7- 000- 2 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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ition ork toe performed under this permit-ch-eck all appy:
HV
_ AC Gas Tank E]Gas Piping _Shutters Q Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ '(Z-2-dd- C:)CD Utilities: Sewer 0Septic Building Height:
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Name oncy l`T. w�— Name: /1GtW1�1S I _
Address: 2,3Z SZ4M Co-kie_tl PL_ Company: ( �rnDlti;F�(' rnFu✓�- mac_
City: r� State:%L Address: /-7-4i CGcst.e S cSle- V
Zip Code:��R /g MZ_ Fax: City: Sim t f-e-s— State:,
Phone No.777, yliL/- S,ZZ/ Zip Code: 33YS8_ Fax:
E-Mail:6ein ( 0 AA-• ►1+e,E7 Phone No. .V'g-/ - �Z�7� CiZG'z-
Fill in fee simple Title Holder on next page(if different E-Mail: •1�1 VV, W1, C-0 VVVP Ie-4e c.owe.Fpd F
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
,SUPPLEMENsAL,G4NS RU�/TIQ�U,LI N LAW/1 ;F,�RMATIQ /f ,� /y/�/' �, ��'%�
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 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 Notice of Commencement.
Signatur of Owner/Lessee/Contractor as Agent for 0 er ;r.�
g ure of Contractor/License Holder
STA OF FLORID ATE OF FLO
NTY OFyw. rA e--q COUNTY OF r&:� Q 0
The forgoing instruipent was acknowledged before me The forgoing instrulnent was acknowledged before me
this day of w — 20Z 5y this 1day of 0%-< &^3 /� 20_Z!I-by
19 oL -4 A-wt a�-5 '16 _CirQ�►►��
Name of person making statement Name of person�aaking statement
Personally Known t--'OR Produced Identification Personally Known � OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(sig(ifure of Notary Public-State of Florida) (Si ture of N -
- — ,,01",118,,,, JASON R SEVERINO
"""' JASON R SEVE."
Com issi n .� Co fission 'r Conutnssion A FF� S��74
:=
Comet ssion N FF 234474 '� E My Commission Exprres
o,:
My Commission Exp les May 26, 2019
Mriv 26. 2019
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17