HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE
INFO MUST1 BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: I/T� �"a
RECENVED
BUilding Permit Application AUG 2 9 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 L-=f' Residential
PERMIT APPLICATION. FOR: CbJ2 `
Address:
Legal Description: w�- 'v
JD
Property Tax ID#:�T�S- V � - lS1_�• D ��' Lot No.
Site Plan Name: Block No.
Project Name: yt'/ee� ��a�i"f'i�4 pgne_l
Setbacks Front Back: Right Side: Left Side:
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ctmd SPtr✓16e rp"d Lor_ fyrrC' o ° rerrtaI '
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Additional wor to. a pertormed under tis permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_L-61'ectric —Plumbing —Sprinklers —Generator —Roof Pitch
Total Sq. Ft of Construction: Sq. Ft,of First.Floor:
Cost of Construction:$ 100e, ° Utilities: —Sewer —Septic Building Height:
Name gar AJLlr I_12Vz- )P/&4-AE 0WA&Y Name: All &Q z
Address: D Company: J �;,g12g�wPsah
City: Address: /f,[1 6"a'd a
Zip Code: 3 tlf9'/�9 Fax: city: Stater
Phone No. 1 �S�— ���C;L Zip Code: 3!!E2 L/!2 Fax:
E-Mail: Phone No X70-5']3_ O
Fill in fee simple Title Holder on next page(if different E-Mail cfVC4-hd0s "42
from.the Owner listed above) State or County License
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 attor,. , a#o�e
commencin work or recording our Notice of Commencement. . !,
W^p +r
Sign$ll of Own essee/Contractor as Agen � lwil Sign r f Contractor/License Holder O�?�
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STATE OF FLORIDA _ m STATE OF FLORID
OF W � 2 COUNTY OF 00- -
COUNTY -
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The f r Ing Instrum nt was acknowledged bef a n o The forgoing instru ent was acknowled9 pe# f$, e
thisday of 20� by m this day of 20 a� J
c*•�obJ '���
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(Name of person a knowledging) (Name of person ac nowledging)
(Signature of Notary ublic- ate of*FTo-rida (Signature of No Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW , REVIEW REVIEW . . REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.