HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE(INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED Yy _
Date: $/25/�? Permit Number: q
RECEIVE®
•
Building Permit Application_ AUG 2 8 2017
Planning and Development Services
Building and Code Regulation Division PERMITTING
2300 Virginia Avenue,Fort Pierce FL 34982 Lucie County,FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: L jLJ_& L
Legal Description: '39/ 14 - 1501 - 1969 - 31 7 S+-L jcj NZD&
o
Property Tax ID#: 3 4,1�f SO 1 SSS 0 -- Lot No.
Site Plan Name: yn V61Y1 t45 C 9 Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
e;S-ro SCM L-1 kE POP- 1-1 WE;
5144AA44
CONSTRUCTION INFORMATION:
ona workrm
to e e Oe un er this permit-check all
appy:
Add
Gas Tank ❑Gas Piping _Shutters a Windows/Doors
Electric 0 Plumbing Sprinklers E Generator E]Roof Roof pitch
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ '3500 Utilities:n Sewer E]Septic Building Height:
OWN ER/LESSEE: CONTRACTOR:
Name NAN t-}- Jt7 FL0(Z(,1A FAS4:Cp&*R Name:_
Address: L . %4 WV�Ctrn div 12: Company: AS 50(_ryVfA-) Al iq O�-?60ST
City: a(k> ` State:N Address: �{�a�JP C(It.
Zip Code: l 123{ 7.24 Fax: City: Q�. ��'L,y�I Stater
Phone No. -72 '2_-3Lfy--�1 obQ Zip Code: 3 V 1 S'2 Fax:772.-33 5-75-Oc?
E-Mail: Phone No. -7:2 Z-33-,�--76M
Fill in fee simple Title Holder on next page(if different E-Mail: TA-S Sd C hl^YW O 13'61156(/-4-6yJi4
from the Owner listed above) State or County License: 64COCO S:762Z
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
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.tucie 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'lendei-or an'attorney before
. commencing work or recording your Notice of Commencement.
C,
Signature of Owner/Lesse /Con ractor as Agent for Owner Signature of Contracfor/License Holder
STATE OF FLORIDA '+ STATE OF FLORIDA
COUNTY OF , U path, COUNTYOF S ? L.UGI.15
The fgrV)ing Instru ent was acknowledged efore.me The forgoing instrument was acknowledged before me
this_AA day of 20�gby thisoZS day of/'0 UGUs T' ,2017 by
Name of person making statement Name of person making statement
Personally Known-OR,Produced Identification v Personally Known /' OR Produced Identification
Type of Identi ication Type of Identification
Produced Produced
(Signature of Notary Public-State of Florida) (Signature of Notary Public-Stat o.. ?G, s DAVID CARL D ITT f
.......
Commission No ;,� V REN S. NIELSE Co mission No.'• r/gg� y e COMMISSION F 1:9208
Commission# FF 1156 37 '.,,±r:' 'iii EXPIRES January 1 619
oFig Iy
cis My Commission Expires (4w)398-0153. FlorldallotaryServic .c 1
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
COMPLETE
DATED
Rev.8/2/17