HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 1
Date: S Permit Number:
�a RECEIVED SEP 06 2017
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 _
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: (70YO L x"w io LI)v-
Legal Description: Lc. e_ c. PGA �► I l -� �� 3 3 - 3 Z 3L K rq La f- .3 Z_
PropertyTax ID#: 33 3"1 So ( b n y 6 O o o ''( Lot No.
Site Plan Name: Block No.
Project Name: Ir'�i 'I- ��� �✓��
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION:_OF WORK:,:
� 16.0 -J.�t 2.v`-I,C/ d C1 1 S 1 2 e- ��� S/ 2-
CONSTRUCTION INFORMATION:
Additional wor toe partormed under this permit-checK all appy.
HVAC 0 Gas Tank ❑Gas Piping _Shutters E[Windows/Doors
FlElectric 0 Plumbing Sprinklers E Generator 1:1 Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ L 3.50 Utilities.. Sewer OSeptic Building Height:
OWNER/LESSEE:' CONTRACTOR:
Namee-rJA $M&uree4-\ 61-, Name: —1
Address: Q0 3`1 L Company: Qb ?, L. re
City: L 2w 5 fa r-,� State:MI Address: ,3 L31 S C l �
Zip Code: LI 9 15-r, Fax: City: 1;—A. State:-P—L
Phone N27z- `6 2_1 Zip Code: 3`t`>�l'1 Fax:
E-Mail: Phone No. '1 SSI Z S'a 6
Fill in fee simple Title Holder on next page(if different E-Mail: 0 Pa' (0 GJ r 6u:l e,-5 L0 m
from the Owner listed above) State or County License: s LC- L-6
L6-c- I "p i
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
-SUPPLEMENTALCONSTRUCTION,U'EN LAW.IN,FORMATIOW
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: 1 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 attorney before
commencing work or recording our Notice of Commencement.
Signature of Owner-Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF COUNTYOFORIDA STATE OF/1�!/�Z7in1 COUNTYOFORIDA~AX
The for mg instrument was acknowledged before me The forgoing instr ment was acknowledged before me
thisLLay of (¢�y�ST ,20/7 by this213iay of T 20Z7 by
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known_ OR Produced Identification
Type of Identificatidn Type of Identification
Produced Produced
(Signature of Notary Public-State of Florid ���•pF1LAM C�94�ii (Signature of Notary Public-State of Florida pELL41,y
Commission No.r 1 rI 115(ai , MI
*. embe'o'�•' `�' Commission No! �Ina(O e .�Q� Bs�oy9�E�
s*: C-Y 8,fit,•; l 50
z: •• m9• �• �• Viz:
101861 it ZV
REVIEWS FRONT ZONINffy` ;• FIs PLANS VEGETATION SEA TURA '••• G�tQ,V
COUNTER REVIEW`��i��/ •• ����� REVIEW REVIEW REVIEW ��i� bV4
DATE lllllllll{IN� I/III11111111H�
RECEIVED
DATE
COMPLETED
Rev.8/2/17