HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: /a 9' 1-7 Permit Number:
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Building Permit Application OCT ®9 2017
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
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PERMIT APPLICATION FOR: 0! k' (191 lkom COT
PRQPOSED1[ RRC}1/EMENT LQ;CATION
Address: 7 � TL �
Legal Description: U1C� SS 4
Property Tax ID#: Lot No.�
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCR(PT(QN ( F WOR41
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CONSTRUCT[ON iNIF MATION
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Additional work to be pertormed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Vloof 5(N 144tch
Total Sq. Ft of Construction: 0-4 40 Sq. Ft. of First Floor:
Cost of Construction:$ Utilities: —Sewer _Septic Building Height:
ER ESSE. CONTRACQR
Name Q Name: 11 pp
Addr . -kP.i ply Company:
City: I,LU&L State ddress:
Zip Code:3Ac(.5Z-, Fax: City: State:.—W----
Phone No. 77Z—7S-r73�f0 Zip Code:--9 Z Fax es � "D-� v
E-Mail: Phone No7 tim �S
Fill in fee simple Title Holder on next page(if different E-Mail S Suet-
from �
the Owner listed above). State or County License '. r-6 -7.*&14
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If value of construction is 2500 or more,a RECORDED Notice of Commencement is recluired.
SUPPLEMENTAL CONSTRUCTION LIEN:LAW INFORMATIQN
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DESIGNER ENGINEER: of Applicable 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/CONTRACTO.R.'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 thepermit holder to build.the subject structure
which is in conflict with any applicable.Home OWners Assoaation.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 ofthis 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 use°s to another noxa-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.
Signature of Owner/Lessee Contractor as Agent 16r Qw 6r Signat_ e of Contractor/License Holder , e�
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STATE OF FLORID , n -' `� STATE OF FLORI T LL
' `'�` COUNTY O
COUNTY OF i z F
The forgoing instrument was acknowledged befor The fo oin instr me t was acknowled d'be
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this day of ,ala-f 20L7 by i this day of 20 b ¢>-Lu
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(Name of p son.acknowledging (Nameof pers n acknowledging)
121nA' (S. AIA
(Signature of Notarub' - tate of Florida) (Signature of Notary P c-Sta a of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission N..,o. (Seal) Commission.No.- (SeaT
REVIEWS FRONT ZONING 'SUPERVISOR PLANS VEGETATION. ,. SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED-
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