HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED.
Date: Permit Number: �1 d�Jda, 0
.. a 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: a�.
Address:
Legal Description:
Pro pertyTax ID#: =5 2r 2!26 (. R,- -del
Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
-
i -
Additional work to De performed under this permit-check all tat appy:
Mechanical _Gas Tank _Gas Piping _Shutters _X_Windows/Doors .,
_Electric -7Plumbing. _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
d
Cost of Construction:$ �-4 Utilities: —Sewer —Septic Building Height:
Name Name: C.
Address:2 2�1 e�/ AkL' - Company:
City: State: . Address:r
�y
Zip Code:� meq-. — Fax: City: ��C-, State• -
Phone No. 7A Zip Code: Fax: d
E-Mail: Phone No .T la/ I/& A
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License c r c e 7 Qd
If value.of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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.
Signature wner/Lessee/Conjactoras Agent for Owner Signature of Contr or/License Holder
STATE OF FLORIDA STATE OF FLOR)DA
COUNTY OF 1_`1 COUNTY OF 55}• t-�lc �
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this%'-\ day of 4�q ,2011 by this A!�_day of S 204 by
o C o Z-e�rw�-F C d v1 Lc V%CA
(Name ot person acknowledging) (Name of person acknowledging)
(Signature of Notary Pu ' -State of Florida) (Signature of Notary Public-State of Florida
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced JProduced acARIS Glus:e:g�_ 1,
DEANNA NIARIE OVENS ':_ SAI SIGN#GG=023
... �Y �
••V PU�•.
Commission No. �5 =: N(1�P,81�MISSION#GG 022023 ommissi �`l�, a ecember10,2 Sbalj
EXPIRES:December 1G.4". ....... Bonded Thru Notary Public IJndenwr�te.-s
BonNota Public Underwrlte •`• "••
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW,
DATE
RECEIVED
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COMPLETED
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