HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1`� Permit Number:
RFCU"D SEP 212017
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:
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PRC3POSED_yI1PRC?UEMENT LC►CATIQN `a ' ht;s
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Address: 5561- '5ar' e - Dr-- F•1 P,erep 3,l4 s1 Z
Legal Description:
Property Tax ID#: 3`162.- c,t o - /iq_nczn -_3 Lot No.
Site Plan Name: 6,u 6}rA-f 6ej _ iv; Block No.
Project Name:
Setbacks Front i/ Back: Right Side: Left Side:
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CONSTRU IC�31U INFORMAf(ON � � r F s � Q � k � '� ; ti ;
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Add itiona wor to be pertorinprl under tis 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: $ '799,66 Utilities: —Sewer _Septic Building Height:
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Name
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Name Wi f(1c,�C���s-�e� Name: r:c_
Address: Company: A--1C,1 aQ4Aq1e1 de)�4:
City:' Perm State: j 1 _ Address: 6LIC,
Zip Code: 3Sg4a7 Fax: City: 60 State: rG
Phone No. Zip Code: 3V-43 Fax:
E-Mail: Phone No `7?2Zp- �C:S/z,/
Fill in fee simple Title Holder on next page(if different E-Mail JCxAC- go, a4':az1: C,5z#
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
Sl1PPI I MEI C®NSTRINV CTION LIEN LAW INFORrMATCaN.
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 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.
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Signat a of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF 5 N . L- %K
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this�1 day of Se Q�2011 by thisal day of Se!P} 201a by
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(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary P blic-State of Florida) (Signature of Notary)5ublic-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification ` _ Type of Identificatio oPayp DEANNAMARIEGI ENS
Produced �` — �0 G�„��rc .V Produced �- SIGN#GG07_'L023
p ANNAAAXRIE eN: :S
Y PU•••a 'O�
I `a � MY CDM SSI4N#GG 022023 �`� .ro EXPIRES:December 16,2020 I�
Commission No. '��. � Commission No. 4�:5„ � ondedThnrNolfaff�Undervariters
EXPIRE ea4mber 16,2020 t
1 o? N Noted public undervriteM I'
1=or o? Bonded Th
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014