HomeMy WebLinkAboutBuilding Permit Application Sep 17 2017 1:03PM HP Fax page 2
ALL APPLI BLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: '' S'a0 13 Permit Number: "1 -0
RECEIVEDSEP182017
Buitding Permit Application
Fanning a d Development Services
Building ani Y Cade Reguktion Division
2300 Virgin ra Avenue,Fort Pierce FL 34982
Phone:(712)462-1553 Fax:(772)462-3578 Commercial Residential
PERMIT 4.PPLICATION FOR: To Select from dropbox, click arrow at the end of line
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ddress: . 0 l S 0.' fi.
egai Descri tion: 1i; E LQ} o - 1 6
roperty T ID#• LE5115.w o s 19 D o b 1A Lot No.
ite Plan Nae: Block N
roject Na e:
Setbacks Front Back: Right Side: deft Side...,!
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g .o "s 'nsia"I I tWilli,
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I a o orme un er s permit-check a app :
[HVA GasTank 0Gas Piping _Shutters Q Windows/boars
OEle is 0 Plumbing Sprinklers In Generator R Roof Roof pitch
Total Sq. Ft of Construction: S .Ft.of First Floor:
Cost.of Ca truttian:$ 7 Q ` Utilities: Sewer 0 Septic Building Height:
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Name L c.e Bo f r.•k i 'I Name: bat- Her, IS -_
Address: .3 S WbOkk Ln ?xJ51?51Company: Lr xv' C 4 fie& i a. d F n
City: Q11``5 Rv'h e W1 io51State: NY Address: SL\\
Zip Code: 10S`Z 6 Fax: City: 5_r-� Ip r Ge State--FL
Phone No. 91-1 Zip Code:_3 AQ S j Fax:
E-Mail Phone No. Z7 -1A60- -2-66S
Fill in fee A nple Title Golder on next page(if different E-Mail: a,,rcdA k . I a I o . tom
from the 0 Nner listed above} State or County License: G i kk 0 S
If value of cc nstruction Is$2500 or more,a RECORDED Notice of Commencement is required.
Sep 17 2017 1:04PM HP Fax page 3
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ESiGNER/ NGINEER: _Not Applicable MORTGAGE COMPANY: Not Applic ble
lame: Name:
ddress: Address:
ity: State: City: State
ip: Phone Zip Phone:
EE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: _Not Applic ble
ame: Name-
Address: Address:
ity: City:
p: Phone: Zip: Phone:'
0 NER/CO TRACTOR AFFIDVIT:application is hereby made to obtain a permit to do the work and installation as indicated.
.1 c rtify that n work or Installation has corgmenced prior to the Issuance of a permit.
St. ucie Count makes no representation that is granting a permit will authorize the ermit holder to build the subject str cture
wh ch is in con ct with any applicable Home Owners Association rules,bylaws or an9covenants that may restrict or prohi it such
str cture.Pleas consult with your Home Owners Association and review your deed for any restrictions which may apply.
in onsideratio of the granting of this requested permit,I do hereby agree that I will,in all respects,perform the work
in ccordance ith the approved plans,the Florida Building Codes and St.Lucie County Amendments.
Thi following bi ilding permit applications are exempt from undergoing a full Concurrency review:room additions,
ac ssory strucl ires,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential us
W RNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice r
im 3rovemer s to your property.A Notice of Commencement must be recorded and posted on the job ite
'be ore thJi'
spection. If you intend to obtain financing,consult with lender or an attorney before
co mendk or recording our Notice of Commencement.
y
Si nature t/Lessee/Contractor as.Agent for Owner signature of Cont4 Holder
ATE-OF F ORIDA STATE OF FLORIDA -
C LINTY OF 14-L-,c. COUNTY OF
Tilie fo�r�ggo�in i strument was acknowledged before me The forge ing instrument was acknowledged before me
t is i5'*"'.day'f _%)g< 2QL by this iS. day of eF�F G+�.�, ¢,r 201 by
e.r�L.14 enn1 �' e'� L. 4y n ;
Nam off person making statement Name of person making statement
P rsonally Knwn ZC . OR Produced identification Personally Known _ OR Produced Identification
T pe of Identi cation of Identification
P oduced .""""�• PATRICIA A.GARYON Pro uced
=r° Notary Public-State of FI rida
'•. ; My Comm:Expires Oct 13, 018
Commission #FF 1335 0 a,7,..z uo�_ (�, , _ PATAICI A.GARY N
° ' ar atuxe'of Nota Public- !�! 'dlg otaiy Pi,6li tale of I da
..( ignature of otary Public- Notary y Comm.Wires odt 1 , 11
^Y, P�,-' t•.ammissio #FF 13
Seal Commission No. t33�8b %.;�:«5;. !�e�7
C mmissioti N... 133S�o l •� fE0. Through YallorialNat y sr
EVIEWS FRONT . ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANEOVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVL W
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R CEIVEi)
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COMPLETED
Rev.812/x27