HomeMy WebLinkAboutBuilding Permit Application All APPLICAB E INF MU T BE COMPLETED FOR APPLICATION TO BE ACCEPTED d
Date: ! Permit Number: I1z 0 d
21� _ RECEIVE®
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
PERMIT APPLICATION FOR:
bPOSED INPROVEMENT LOCATION
Address: lS� C r
Legal Description: t 6 AUL
Property Tax ID#: Lot No.
Site Plan Name: � .AU4_0_ dtAQ Block No.
Project Name: _
Setbacks Front Back: Right Side: Left Side:
DETAILED K DESCRIPTION OF WOR
\ � CSS L
CO ' MUCTIQN INFORMATION
Additionalworkto _e performed un er t is permit-.check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters Windows/Doors
_Electric _Plumbing _Sprinklers _Generator v Roof -!rt6426ch
Total Sq. Ft of Construction: Z09150 Sq. Ft. of First-Floor:
Cost of Construction:$ 9660`Od Utilities: Sewer _Septic Building Height:
0-WNER%LESSEE. CONTRACTOR
Name-Rpf(AA Zejw&b 1G1La CZ] Name:
Address: SAPSiWeU4 Company: L
City:NA&-` ,Lo6.0— Stat _ Address:
Zip Code:? Jj-g7i Fax: City: yam,., State
Phone No. 772,-' �S'-''�Z�`'S Zip Code: 0 Fax: �G
E-Mail: Phone No 77" "3s�
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
Lvalue of construction is 2500 or more,a RECORDED Notice of Commencement is re uired.
SUPRLElVIENTAL CONSTRUCTIQN LIEN
LAW INFORMATION
DESIGNER ENGINEER: of Applicable MORTGAGE COMPANY: ✓ ll�ot Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: of Applicable BONDING COMPANY: of 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 pefmit holder to.build the subject structure
which is in conflict with any applicable Home Owners.Association rules, bylaws or,and covenants.that.rhay.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, l 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 iwyour 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.
Sign re of Ow r/Lessee/Contractor as Agent for Owner Signature of ontractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF � COUNTY OF 'S L
Thepr instru nt w s acknowledge ore me The f ing instrument was acknowledg efore me
this day of 20 y this day of � (��_ 20��by
(Name of person� knowledging) (Name of perso acknowledging)
(Signature of Notar ublic-State of Florida) (Signa otary u lic-State of Florida );
sr naRynow` o ced Identification er"soak . w ANG! P ,f�u ��ddentification
f e- Qfi f"-att
r a adF . I7. of Flonda _ J' Q�mrriission # FF 234730
Prodaa. .Via, °Q,
Pr nmmicsinn i FF 23 730 —. c ,�e Mt rnmr7 Fv iicn c Mgv 97 7(11�i
�, or F� .
rp° My Comm.Expires May 2,7,2015{ "� "���1, B ndedihrough PJational Notary Assn.r,,� ' ' '
�26M issib:ndNbbrcughNational AotaniA.ssn', (Seal) Corrirrlission-N '� (Seal),
REVIEWS FRONT ZONING . SUPERVISOR PLANS VEGETATION. SEA TURTLE ' MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW ' r REVIEW REVIEW
DATE
RECEIVED'.
DATE
COMPLETED
ev. 712014