HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED u q
Date: ti0 �ti31 �1 Permit Number: J1 NO 03 1 1
RECEIV'D OCT 13 2017
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 f
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
PRD OS' D 1N'PR®1/EMENT'
ANTI IN l\I.•
ddress: I 13 5 S. 9(ockr,M4yi ed . o,(k- �Suc�
gal Description:
P"roperty.Tax ID#: Z 17 - 2 11—0020- 000—3 Lot No.
�
sit ,Plan Name: Block No.
6'Project Name: AN t SQL LJ/aUTEO S
Setbacks Front Back: Right Side: Left Side:
cs�i�, 4r L y" ��` i v cam° 7600
�C f; NSTR C�TlO' INiFO � �TION'
rtional work to be performed uncler 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:$ �� ' Utilities: —Sewer Septic Building Height:
U60M, MEANST0
N,ame;�, `��Ar�iEL"i' li� '�r�G'�LS" sName: ;
��::;;-L4
Address:,, l�'3S fT -��cirj C,Iv►rf�N AD -- Compaiijr:
City: F06L i '1 2t State: . Address:
Zip Code: J!4CiV{( Fax: City: F1 4-� Stater
Phone No. ::7':�?7 311cl- Zip Code: 3�( G"S Fax: E C6G-7
E-Mail: x�1�0► q(� ac,.kE�a-I , _ Phone No bt 3
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
i
Sl1�P ' `ENI �N eAL CONS "R. CT'tON I�EfiI L�►W IN!FORM-Art1�ONy
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.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA /
COUNTY OF SE-. �CI-2 COUNTY OF �-t—• CEJ G
CThe for oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of �JC , 20 17 by this 'f day of G� 20 /7by
(Name of person acknowledging) (Name of person acknowledging)
csy-n n a.- o �
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced G DRAWDY Produced •'�r' YN G DRAWDY
OMMISSION#FF198558 Y COMM�c)SSION M FF19855a
Commission NoCommission No.��' .:
iu:A_�IRESA@ ry 11,2019XPIRES�I wary 11,2019
14
140•'78-0153 Floridallota Scrvicc:con' nwidpNotary3ervicacon•
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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