HomeMy WebLinkAboutBuilding Permit Application ALL,APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECEIV-D,
Building Permit Application AUG 2 3 2017
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 t"_z
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Address:-661, 9 (60&1
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Legal Description: IqAJ t0Pr
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Property Tax ID#:3q02- &0 5-. 640�7 - Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additional-w-orktoben rtormed under this permit-check all that apply:
0HVAC — -] F ]Gas Tank F Gas Piping Shutters 19,W' lndows/Doors
Electric FlPlumbing OSprinklers F]Generator F] Roof
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Total Sq.Ft of Construction: Sq- Ft.of First Floor:
Cost of Construction:$-Log 'J . 3 Utilities:F ]Sewer F]Septic Building Height:
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Name C hase o A 94-rocAWC L_L)5 T`Ek Name:
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Address: 0o4 Company:!'__V_.�_(._� Oc_�'c-�Q-C- i.City: e- r 0- State: L Address: (D 11
Zip Code: -3 Fax: city: i C. _State:_E_�--
Phone No.:2 Zip Code:-3sj, i Fax: 54
E-Mail: Phone No. Lei �J C'5
Fill in fee simple Title Holder on next page(if different E-Mail:
from the owner listed above) State or County License: 0
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
TAddress:
DESIGNER/ENGINEER: NotApplicable ORTGAGE COMPANY: Not Applicable
Name: ame:
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:
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 yo property. A Notice of Commencement must be recorded and posted on the jobsite
before the fir ins p coon. if ou intend to obtain financing, consult with lender or an attorney before
commenci or r recor i our Notice of Commencement.
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nat re of owner/Lesse Agent ignature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLO�{DT A
COUNTY OF_ ��� COUNTY OF i :in
Thefq5going instr ent was acknowledged before me The�fo}rgroing instr ment was acknowledged before me
this da of A--- 201-7by this.0 day of 20 by
(N per o ging (Name of per on acknowledging)
tur lorida} (Signatur of Notary ubiic State Florida)
Personally Known OR Produced Identification Person liy Known__ZOR Produced Identification
Type of identificati4d;k—duced Type of identification Produced
Com is No!�x \3 ,'gyPi:';••, I�J� RRACCIANO Commission No. 'C5�4FYPJe< ANGELATSM)
• Notary Pubtc—state ofRodda * v MY COMMISSION#FF 951069
t CommissfonOGU472432 N� '_ - EXPIRES:Aoril12.2020
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Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS