HomeMy WebLinkAboutBuilding Permit Application Aug 31 1712:31 p First Choice Plum• Y _ 71287 7860 p.1
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTS
� Permit Nuber: �01® to_Date: 1�
RECEIVE
Building Permit Applicatic n AUG 31 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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow a the end of fine
PROPOSED IMPROVEMENT LOCATION:
Address:I 1tY1 S
Legal Description: +C1 a-
�vL S `i
Property Tax ID#: X11 C1-5 • - Lot No. 'a
Site Plan Name: Block No._Lk?)
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work toe e orme under this permit-check a appy:
HVAC El Gas Tank []Gas _
Gas Piping Shutters a Windows/Doors
Electric ®Plumbing Sprinklers ElGenerator Roof Roof pitch
Total Sq.Ft of Construction: S Ft. of First Floor:
Cost of Construction:$lt�.[7t] . C)Q Utilities:0Sewer[--]Se tic Building Height:
OWNERAESSEE: CONTRACTOR:
Name Name:
Address: Company: 36
City: -A- ` 7 C a'P State: Address:
Zip Code:-NACIS3 Fax: City: State:
Phone No.`"a.• 22T:3• �;1ykp(_0 Zip Code: Fax:'C 1a VWL N UDD
E-Mail: Phone No.'l-1 - N L
Fill in fee simple Title Holder on next page(if different E-Mail:il
from the Owner listed above) State or County Lice se:(' ! 1117" 3�g
If value of construction is$2500 or more,a RECORDED Notice of Commencement is reqt ired.
Aug 31 1712:31 p First Choice Plum* 7728797860 p.2
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMI ANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: P one: I
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPA Y: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: PI one:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit ft 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 perrr it holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or ano cov Hants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for at iy restrictions which may apply.
In consideration of the granting of this requested permit,I do hereby agree that I will,in a 11 respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Lucie County Ar iendments.
The following building permit applications are exempt from undergoing a full concurrent review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory u es to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement ma I result in your paying twice for
improvements to your property.A Notice of Commencement must be recc rded and posted on the jobsite
before the first inspection, If you intend to obtain financing,consult with I nder or an attorney before
p Y l;, Y
tommencing work or recording our Notice of Commencement.
1 `
Sig6a re of Owner/Les ntractor as Agent for Owner igna ure of Contract r/License Holder
STA E OF FLORIDA r ST E OF FLORID
COUNTY OF l � COUNTY OF
The for o'ng instru ent was acknowledged before me The forgoing instrum t was acknowledged before me
this day of ^^�20 It by this day of v 20 by
Name of pery5emaking statement Name of 7n —
Produced
making statement
Personally Known OR Produced Identification Personally KnownOR Produced Identification
Type of Identificatio Type of Identificat
Produced
(Signature of Notary Public-State AM° ignature of N ary ublic-Sta
`1hNCV LEE LANGFOD ao' (
�yLE£LnAN'
GFORD
Conwssiox4GG20 7.f mmission No. � o2,0Commission No. 03 , JEJQRES:October I2,202
opn-01EXPMEOctber 1220
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETAI ION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17