HomeMy WebLinkAboutBuilding Permit Application 0.
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /— ®-1-7
Permit Number: \1 d`� 'd a2z
RECEIVED SDP 2 0 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
Address: ® S I �. f211� C,�T yq
Legal Description: 0149WIK� V1LVfaL )�iY7-H Com AO # U417- /YR1upg-L0,4
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Property Tax I#: e'�,s�1 ^- ��0 O/,57/- d®o— l Lot No.
Site Plan Mame: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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rtiona wor to e e orme under tispermit—check all t=appy:
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HVAC Gas Tank Gas Piping _Shutters Q Windows/Doors
Electric 0 Plumbing [:]Sprinklersa Generator 0 Roof i=
Total Sq. Ft of Construction: S . Ft.of First Floor: �.
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Cost of Construction:$ !/ Utilities: Sewer 0 Septic Building Height:
Name �T�P#�iicp BO®-T/ Name: �'JiI T �'2Er�1� Tib
Address: J-06% S� 5;�rR.4�(r Cf,-C1.-S Company:
City: STUB State:,L- Address: ��`SL�'
Zip Code:3c/?9 7 Fax: City: o�S'� Cr/CZ State: �—
Phone No.72 Z"- %9 1-766 Zip Code:g9Z.9 6 Fax: 77-7-3yor7y7
E-Mail: Phone No.770777
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Fill in fee simple Title Holder on next page(if different E-Mail: V"i l I&r C �Ej P/'PCCa o C0e-7�4 i
from the Owner listed above) State or County License: Jc_:�
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If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: NotApplicable
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:
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 yo p intend to obtain financing,consult with lender or an attorney before
commencing wo&or recordirilVour Notice of Commencement.
A V7 0 S
Signature of Owner/Lessee/Agent Signature of Contractor/License Holder
STATE OF FLORID At,
t. STATE OF FLORIDA
COUNTYOF COUNTY OF
The forgoing instrument was acknowledged before me The forg ng instrument was acknowledged before me
this&&day of SSAA 20 -Q-by thi oAZdTy of 9:,A. 20 L-L by
IUAJ 9A A oKe num'
GejeAULL
(Name of person a owledging) (Name of erson ackno ging)
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LjSi re of Nota y Public-State of Florida (Si of Notary Public-State of Florida
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0 P1 offib A1,NER 10,
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Personally Know g. - Personally uAlA$W at'
Type of Identific oocoi Type of Ide rodu
1400.01, t=XPIRES ucFoTe--r 11,21319 my commlbblul,4 If r-r-v. k
FforldaNmiftice.com Commissi ExPIRES Oct
Commission No 00100s-01M 0 )ber(t�AF
Revised 07/15/2014
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE is
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS