HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ld W Permit Number:
RECEIVEDi
oulliaiing reir-mtz appilication - OCT 1 7 2017
Planning and Development Services
Building and Code Regulation Division P ER MI I NG
2300 Virginid,4mnue,Fort Pierce FL 34982 St. Lu ounty, F.L.
Phone:(772)462-7.553.Fax:(772)462-1578 Commercial Residential
FF-RMI I APPLICA I ION I-UK: To S61ect from dropbox, click arrow at the end of lineJA
A P
13140POSl=13 iMI'Kt VF_MEN I.LUCA 11014:
Address: &d71
Legal Descriptim; --
Property Tax ID 70a•-6�_��b f Lot No.�
Site Plan Name: Nock No.
Project Name:
Setbacks Front -- -._--- Back: Right Side, _------=LeftSide: _ _
VJ IAIL V LILSE.-141010N OF WOKK:
L11re K�
CONS` OCTIO N.JNF
lana wor o nGssTank
r rm un er is perms —'c ec a I M1-SIVAC �asPiping _Shutters aWlndows/Doors
Electric Plumbing ❑Sprinklers OGenerMr Roof Roof pitch
Total Sq.Ft of Construction: 5 .Ft.of First]Floor_ . .
Cost of Construction,$ �Vx Utilities., SewerMseptic- Building Building Height:
OWI iEOLESSEE: CONTRACTOR".
Narrie 0 Name: tiUg-ti S rTAam0rT5
Address: Company: 0u 3Ta M 6 M'I)
City: /00,tr State:_L Address: 1 '15 S E
Zip Code: W6"9= _ Fax: City: U PT 9t L,uC.r e.. Sm.: �
Phone No. J F z Zip Code: 5 .- _-- Fax: '77-2- A-3 5-1 6
E-Mail: Phone No.
Fill In fee simple Title Holder on next page(if dWerent E-Mail: P_q s t c,.i r s a o hti
from the Owner listed above) State or County License: �� a c 5( $ to
W value of construction is$zwo or more,a RECORDED Notice of Commencement is required.
SUPPL>=MEMIAL.,t'91NIS1.111LICIU. NXIIfN-.LAW.I-NFOFi 4A•.1ION'.
DESIGNERf ENGINEER: _Not Applicable MORTGAGE COMPANY, _Nat Applicable
Name: Name-_
Ad dress: Address:
City: ____ State:_ City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLEHOLDER: —Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City: —
Zip: Phone:T' Zip: _-- Phone:
i certify that no work or installation has commenced prior to the issuance of a permit.
St.L cie County makes no representation that is granting a permit will authorize the permit holder to build the subjQct structure
which is in contlictwith any,applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
structure.Pleasc consult with your Home owners Association and review your deed for any restrictions which mayapply.
in consideration of the granting of this requested permit,I do hereby agree that 1 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 exemptfrom 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 Connmencement may result in your paying twice for
improvements to your property.A Notice of Commencement must be recorded and posted on the job-site
before the first inspection. If you intend to obtain financing,consult with lender or an attorney before
commencing work or rec dingyourNotlee of Commencement.
r�✓ s
Signature of Owner essee/Contractor as Agentfor Owner Signature of Contra or/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF. �U Gl e COUNTY OF_ Xz�V C./-e.
The forgoing instrument was acknowledged before nit- The forgoing instrument was acknowledged before me
this_day of , 20 _ by this_day of 120 _by
eur �(q Pn trorlS &&--r PY1_1MUVt__��
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary.Public-State of Fl a) (Signature of Notary Public-Stat of Flor'
Personally Known V/ OR Produced Identification Personally Known ' OR Produced identification
Type of IdenWica/t�io�n+Produced / Type of identification Produced
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REVIEWS FRONT I ZONING I SUPERVISOR PLANS 1 VEGETATION SEA TURTLE MANGROVE
COUNTER i REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE i— -------------
COMPLETE
INITIALS
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