HomeMy WebLinkAboutBuilding Permit Application SEP-19-2017 TUE 08: 52 AM CENTRAL SCHEDULING FAX No. 3212686138 P- 002
ALL APPLIC `BLE I FO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: \� Permlt Number:
R E C E I'.'r D SEP 19 2017
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Wryinla Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax:(772)4621578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
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Address: 1 v vef CCS'
Legal Description, _ 1
Property Tax iD#:- 1 �' Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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AddltJonal work to be ertormed under tis permit—cneCK ali appy:
0HVAC Gas Tank Das Piping Shutters O Windows/Doors
Electric Plumbing Sprinklers Generator Roof Roof pitch
Total.Sq. Ft of Construction: _ Sq. Ft.of First Floor:
Cost of Constructlon:$ ��ad ti d O Utilities:'USewer Septic Building Height:
r2 r,rir' - ay e: as J� avi r'. j. S loom=
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Name 1 Name: r� Y a�
Address: l -Ale, Company: 1 1 t)
City: 1 c e J State: Ad ss:'04 low t e r i 5c f
Zip Code. Fax: City: t State. �y
Phone No: ��-�� -� �3 Zip Code: F
E-Mail: Phone No, 12` _�
Fill in fee simple Title Halder on next page(If different E-Mall: e I rr rr'�-CCW
from the Owner listed above) State or County rcense. , N L 39
If value of construction Is$2500 or more,a RECORDED Notice of commencement is required.
SEP-19-2011 TUE 08: 52 AM CENTRAL SCHEDULING FAX No. 3212686138 P- ON
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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 madeto obtain a permitto 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 countmakes no representation that Is granting a Permit will authorize the 9 ermit holder to build the subject structure
which Is in conflict with any applicable Home Owners Association rules,bylaws or an covenants that m restrict a r prohibit such
t with your Home Dwners Association and review your dead for any restrictions ay
structure.Please consul which may apply.
In consideration of the granting of this requested permit,I do hereby agree that IL 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 your Notice of Commencement.
Signature of ne Lessee/Contractor as Agent for Owner Signature of onractor/License Holder
STATE OF FL q ^ STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoingin rumen was acknowlecled before me The�qE�olng lnstnjMen�was acknowledged before me
this day this day of
EPPT 2kT.by 20� by
Name of pr on making statement Name f e making statement
Personally KOR Produced Identification Personally Known P r CR Produced identification
Type of Identification Type of Identification
Produced Produced
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(Signature of Notary Public-S �,Ior�d (Signature of Notary Public-State lorlda)
t6iinia Xonger L Catherine Xonger
P% C
Commission No. 3
=000FF172372
OCT 26,2010
Commission'N =Expires:OCT 28,Zola
BONDED THRU rPr BONDED THAV
DA NOTARY LLC A iiii IST FLu RIJ)A NoTARX LLC
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW � REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17