HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED q
Date: 4A S611ii Permit Number:
mac^ tyt•. � t � ce, ;raME r�ez
' - RECEIVED AUG 302017
Building Permit Application
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 V
PERMIT APPLICATION FOR: o
PROPOSED INPR,OVEMENT LOCATION:
Address: o� 11 i �M�� o V i ogQ IZpC'J
Legal Description:
PropertyTax ID#: a� 3"►- $Oa- d`�5'4a0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAIL D DESCRIPTION Of WORK:
C®NSTRUCTION INFO M'A 0!
IM(ti-o-n-al worK to be pe Orme un er t is permit-c ec a tat appy:
_Mechanical _Gas Tank _Gas Piping. _Shutters ` Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch ,
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ ' 00 Utilities: —Sewer _Septic Building Height:
OWNfR/LE�OP@ CON RACTOR:
Name `-1-A R Name:
Address: µ' Company:
City:�Skyn State: Address:--
Zip Code: (0- (�F,ax: City: State:
Phone No. ,�-I- D obo Zip Code: Fax:
E-Mail: Q�C�'1� � ®�f4��,�1��0 . coM Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CON51"R CTI®N L.IiEN LAW INF'ORIMAI"f'0" .:
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 thepermit 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
commOncing work or recording our Notice of Commencement.
Signature of Owner Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLO DA STATE OF FLORIDA
COUNTY OF A'_ L c COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this %0 day of 2� 20M by this day of 20_ by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Pu ic-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Ident' ication Type of Identification
Produced �- pp�} IEGNENS Produced
�.•°••'�: My(;ODApdISSION#GG 022023
Commission No. EXPIRE ' Ober 16.2020 Commission No. (Seal)
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Bonded ThniNotaryPublltUndenNriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/203.4