HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECEIti''D OCT 13 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: ddai
Pla�osbiv:e�RovEMIIVT �acaTloN. =
Address: Ga S- Pr,u r-.o A5 Z Al
Legal Description: RepllicP 46rc,4eP C1c�n/S
Property Tax ID#: 9LI16 - 5o3- 0,*35(- -006- z Lot No. 18
Site Plan Name: Block No. �-
Project Name:
Setbacks Front !/ Back: Right Side: Left Side:
DETAiLED D:ESCRIPTfON,Q.f=WORK
R??42G,a lG JC-7 Nuc s
CONSTRUCTIaN 1NFORNCATIO'N
.
itiona work to be performed under this 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: $ has. ' Utilities: —Sewer _Septic Building Height:
DINNER/LESSEES CC►NTRACTOR:
Name '72m,,,1ti j4 cJ /91c C,0;Fe Name: 7 u. rvorr
Address: �z s Company: A
City: Ford Piece-e State: FL Address:
Zip Code: Fax: City: &SL State:
Phone No. 4Zo - 3oq- n g i v Zip Code: Ty4 S 3 Fax:
E-Mail: Phone No -7-7z-h75--syzi
Fill in fee simple Title Holder on next page(if different E-Mail ei_ L s4�,� ! r; (P enjA
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
7,�17
'TRU E
LCONS, CTIONU N,LAWIN FOR
PLEMENTA
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: N I ot Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain'a Oermit'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 isgranting a permit will authorize the permit holder to build the subject structure
which is in conflict withany 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 your Notice of Commencement.
11-31.1
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTYOF 10r. COUNTYOF 61ir. %.%),�vv,
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this%'& day of 20–n by this VS day of 6 20X]_ by
.5,4.C' 0-'r X' t
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary P'Gbli ate of Florida (Signature of Notary Pdblic-State of Florida
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produce
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IV DEA MARIE efVE?;r,
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Commission No. Wt4-3;h �&'#r'Go" Commis berl6,202(Se
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Bolided Thtu Notary Public Underwriters,
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REVIEWS FRO SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COU REVIEW REVIEW REVIEW � REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
lev. 7/2014