HomeMy WebLinkAboutBuilding Permit Application i
AII'APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED. q J
Date: Permit Number:
.� .� ., . ...MR-
Building Permit Application
Planning and Development Services I
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:
PR®PO�SED INP'R,AION l' LOCATI® :
Address: d C !
1 1I
Legal Description: k a k 4e L to c i P_
rr n
Property Tax ID#: 3y � C�
. - 7,03—01)q0, — d 0 0- 0 � � Lot No.
Site Plan Name: Block No.
Project Name: Jd nG1
Setbacks Front_ Back: Right Side: Left Side,:
D'ET ICED Df�SCRIPTION O"F WORK:
9 Dec r,N y W ACL A, z,./ /1 �
C®°NSTRIJCTI® INFORMATION:
Add itiona 1.wor to be pertormed un er t is permit—check all that appy:
_Mechanical _Gas Tank _Gas PipingShutters _'Windows/Doors
Electric _Plumbing _Sprinklers _Generator Roof
Total Sq. Ft of Construction: Sq. Ft.of First Floor,:
Cost of Construction: $ LN S.,z Utilities: _Sewer _Septic Building Height:
' I
OWNER/LE�S�S`EE: CONTRAC OR'.
Name PrI1411talp JAI)e-1 Name:_ 'rS j �a c
Address: 9Q-7 —'Sg 13Ji Company: Q P S
City: P S L State: Address: oq3 41 � .;l9L i V
Zip Code: 114 9 S I Fax: /VA City: "6-; State: FL—
Phone No. U_ 7 O Zip Code: �9;y 6/ Fax:
E-Mail: Y Phone No 7,7D- /_J 4) Q I Ito
Fill in fee simple Title Holder on next page(if different E-Mail u, h Co w�
from the Owner listed above) State or County License SGe 3 O
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. `
SUPP EMENTAL C®'NSTRIJCT OXN 11110M LAW N,'11
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address: 414
City: State: City: State:
Zip: Phone Zip: Ph ne:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: A City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT: Application is hereby,made to obtain a permit to do the work and installation as indicate:
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.
ignature of own e essee/ContractorAge6 for Owner ' nature'of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OFg—!• J_U t COUNTY OF est. c�.o
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this c -X' day of 11&c c; 2017 by thisc:)44 day of ,20v-) by
��lo M✓?r:3 '91 J L
c��C.tc�� ,� /els-(�lx� �•�c��Cce�c� rto-JrhO-r.�
(Name of person acknowledging) (Name of person acknowledging
(siolture iff Notary Public-State df Florida) igna ure of Notary Public- to of Florida)
Personally Known OR Produced Identifica on Personally Known OR Produced Identification
Type of Id tification- Type of Ide fication
Produced�QC �a20 �0mSEY Produced ' i
Fro-PM
1 �
�. _
JACQUELINE H0ADLEY
�•�pY P///
/�° •- Commission#FF 942489 <P �e'/
Commission Y � : = xpires F��e�l)2020 Commission No =}° .`� Notary Public SE61 1 lorida
9r �,,. )?_•( r _ Commission # FF 94¢¢489
OF Bonded through National Notary Assn. \� ,
l .;,y�: J= My Comm.Expires Feb 12,2020
�,•
n e roug a lona ary ASSn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TUR7L � MA ROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014