HomeMy WebLinkAboutBuilding Permit Application _.;ABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: :
RECEVED
Building Permit Application AUG 17 2017
Planning and Development Services PERMITTING
Building and Code Regulation Division St. Lucie County, FL
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
�PROPOSE�D INP( OVfMENT�LOCi4TIaN t `� ,�.. �' fia. V ., WN",
'
Address: 2 f �=� -C &to
Legal Description:
Property Tax ID#: e3 41 Z2 "2 1 l `C-)oI U C>0 0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
k,,.rK:. �.4
i u f
DETAILED DEN SCRIPTIOOF�WORK
� '"p-;d.r, � at. t: t«t r
- F�.c IT: -713.6 _ : 37 . us-1 ;m ?bora- UIJ
O�-'
Additional work to be performed unclerthis permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ 22 90 -C3n Utilities: —Sewer _Septic Building Height:
"�� .5:
ODUNER/LESSEE Y
� 4.01
ON ,RA
Name f. ,Kr �'( Wt i-e -ft- &Z A' Name: 'Sill L
Address�l Z- 101,141'S L j Company:
City: Lsh o State: Address: /0 t/ 4 ,.S j jigjyPe. Aur-
Zip Code: Fax: City: -,enrT- State:-&-
Phone No. Zip Code: q 49.3 Fax:
E-Mail: Phone No 1-if-5- 2 0 ti
Fill in fee simple Title Holder on next page (if different- E-Mail. �',++i T.4_re.,rV l G tc-,o- 10 M&I L =Lal L
from the Owner listed above) State or County License 7
If value of construction is 2500 or more,a RECORDkb Notice of Commencement is required.
SUyEMEN�(`A�COO NSl'RCICTION LIEN LAUI! PNF®R11/IA1'ION':
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 recqrding your Notice of Commencement.
Signature of Own essee/Contractor as Agent for Owner Signa ure of Contractor/License Holder
STATE OF FLORIDA �1 STATE OF FLORID � f
COUNTY OF ,yC � COUNTY OF
The forgoing instr ent was acknowledged before me The forgoing ins ment was acknowledged before me
this 40-day of 20—nby this lLi day of 20 n by
(Name of person acknowledging) (Name of person acknowle girng~
( ' n ure of Notary Public-Sta _of_Florida ) jai a re Notary Public-State of da)
Personally Known O� !Wdhtific�iticin - State of FI)rP_erpnally Known _ Of Produced Identification
P�1y C nt :res Dec 2.0,2T' eof Identificatio Y ,, LASHAHNAIh C; Atv1
Type of Identification yCommission ##FF 17721 .-��R "°a'sProduced fro uced .oT"� ni r . otic-State of Florida
Bonded through National Notal}Assn. ' _ _My Comm.Expires Dec 2.0,2018
Commission No. (Seal) ommission No. , commis(S.ea:l)FF 177249
Bonded through National Notary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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