HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /—� �� Permit Number: �� d��d'o a3
D SEP 19'2017
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: �� c� `cd►
PRQ�QSED INPRQV.EItENT L}✓.LeA 101Y ' J" �
Address: 760 cl; eoc a iNA-
Legal Description: 1AJU-WyC)0 'Rk- ljwi%
Property Tax ID#:�/3,0/ �� 7 — C�a-t �¢ —000 — `o Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Sider Left Side:
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DETAII ED I ES'CRIPTIQN3FWQRK
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Ae L72 141 rrm�,(
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CQlSTRUCT[ONINFOtMATIQN e $ ;
4 l $
Additional work to be pertormed under this permit—check all that 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:$ /C)Q�S,� Utilities: —Sewer —Septic Building Height:
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Name �$ G✓h-4 rul,u5, LiC Name: " / I6ew ry`z-
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Address: 169c2i A. .4, 'Company: 4914,
eLe(k/-LC-
City: State: Address: 4996 __o9-' e-(X
Zip Code: �0 6 Fax: City: �}2aw �� Stater.
Phone No. 3 --3 Zip Code: '3rOG5( — Fax:
E-Mail: Phone No`]'71,-)t 67/� ,23:20 'r�
Fill in fee simple Title Holder on next page(if different E-Mail 14-e M If G�t'�k&J•g,4?) e+t Cog
from the Owner listed above) State r County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPP�I�EMEITACCNTRU�T{ �I LN tAS�kI3RNIA `L
T .
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 permifto 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 fullconcurrency review: room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessoryuses to another noxi-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement may result in your paying twice for
improvements to you rty. A Notice of Commencement must be reco and posted on the jobsite
before the first in sp ction. f you intend to obtain financing, consult wit end or an attorney before
commencingwork o re rdin our Notice of Commencement.
Signature of Owner ee/Contractor as Agent for Owner Signatu of Cont for icense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF SN-. Vv c;.X COUNTY OF S�Ir"=W cue
The forgoing instrument was acknowledged before me The for ging instrument was acknowledged before me
this \01% day of Sc8 'a 20n by this � day•of SeQ'b 204 by
t r -NQ..N\4\ e.ft t tkz`\��
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary ublic-State of Florida) (Signature of Notary ublic-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identik
ProducedL, Produced •1.. DEANNAMARIE GIVENS
NA #G
GNENS s x"i yWE =M G 022023
Commission No. PD SION#GG 022023 Commission NS >li X RES:December 6,20 0
4. '•; - My I�Rtuber 16,2020 eF te.• Notary Publi1rters
EX? E a
D ry pubic undervml
REVIEWS FRON IONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. "