HomeMy WebLinkAboutBuilding Permit Application OCT-13-2017 FRI 09:00 AM CENTRAL SCHEDULING J FAX No, 3212686138 P- 002
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION To BE ACCEPTED
Date!,, 8- 17 Permit Number:
Building Permit Application OCT 1 201
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 38982
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, Glick arrow at the end of line
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Address: S «c 224q r,-5
Legal Description:L CJW(4 QK L*\
Property Tax ID#: 1 ADO- Lot No. 13
Site Plan Name: Block No.
Project Name:
Setbacks Front Back:_ Right Side: Left Side:
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ional wor t❑ e armed under tis perms W c ec gill• appy:
1_1HVAC f]GasTank pGas Piping _Shutter ❑,s Windows/Doors
Electric plumbing Sprinklers F1 Generator U Roof Roof pitch
Total Sq.Ft of Construction: Sq.Ft.of First Floor:
Cost of Construction:$ Utilities:LnJ Sewer Septic Building Height:
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NameCAC O Name: e
Address: Company:
City: r State: Addr s: 1 '
Zip Code: \ Fax: City. �� �►�- State:
Phone No: �2. ` Zip Code: g� FaxJ3L.D?'5'" 3: l d
E-Mail: Phone No. - lan
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'Fill in fee simple Title Holder on next page(if different E-Mail: ") k\•(b
from the Owner listed above} State or County Lice e:
If value of construction is$2500 or more,a RECORDED Notice of commencement is required.
OCT-13-2017 FR1 .09:00 AM CENTRAL SCHEDULING FAX No. 3212686138 P• 003
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DESIGNERICNGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name; Name:
.Address: __— Address; -_
City: Stater City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE MOLDER: _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 represeiltation 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 Assodatlon 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 5t.Lucle.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 I or
Le sOlcontractor as Agent for Owner Signature C ntractor/License Halder
STATE OF FLORID STATE OF FLORipk�
COUNTY OF COUNTY OF
The forgoing instrument was ack owledged before me The forgoing Instrument was acknowledQeebefore me
this day.of � 20�.by this da of C ��b�Q � 20 by
Name of perso making statement Name of person making statement
Personally Known OR Produced Identification ___ personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
'� t Brine Knnger of Nota Public- " loridaatherine
(Signature of Notary Public-St t flat' (Signature ry Sip, C i Konger
Commission N r• C Dii#FF17237z Commission No. Cp fon#FF172372
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17