HomeMy WebLinkAboutUntitled ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECEIVED OCT 18 2017
Building Permit Application
Planning and Development Services
Building and Code Regulation Division ,
2300 Virginia Avenue,Fort Pierce FL 34952 y
Phone:(772)462-1553 Fax-(772)462-1578 Commercial Residential /\
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line ca
Mimi
Address: r �1S �11 °
Legal Destrlption: ) 14 -Uf•t`•(- a C)a
Pro pertyTax iD#: '&Q-,500 019 1. 00 v _-r Lot No.
Site Plan Name: Block No.
Project Name: -
Setbacks Front_ Back: Right Side: Left Side-
"Dce-meei '� 0 NNS�dJj V a 1 G{,V4
�S -Tt)fJ 16
niona war o e e armed under this perm -check all app y:
VAC Gas Tank DGas Piping _Shutters . ❑Windows/Doors
Electric Plumbing ❑Sprinklers Generator Roof Roof pitch
Total Sq. Ft of ConstrUction: S�of First Floor:
7fl a� a
Cost of Construction:$ Utilities: Sewer Septic Building Height:
Name PRO I~ Lt G f,+1 Name: eoaq.5 . 5
Address:114*1-.Al4e WT4gt-frctkt --tt a O a Company:SVC ' C''O -�HA mpou;,e,
City.flbjTg�' Lu cie- State:;Fi- Address:aL5ss `J'E' &C("00 P►*' C?
Zip Coded q9l Fax: City:&- y
- - _� G1 . .. -- -..__... stater l
Phone No. %3-3'0 ' 05 Q _ zip Code:3 `f 57A Fax:
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County license: CK 'OgRG 5O
If value of construction is$2500 or more,a RECORDED Notice of Commencement Is required.
QE5IGNEIf/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: 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: Zip: Rhone
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
fcommencin work or recording our Notice of Commencement.
I
s _
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor License Holder
STATE OF FLORIDASTATE OF FLORIDA �} j
COUNTY OF COUNTY OF /"fc►r_t''>
The forgoing instrum.' t was acknowledged before me Thefor ''ng instrument was acknowledged before me
f this—day of 20 Lby this 27 day of JVAIG 20 L.by
(Name of person acknowledging) (Narne of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Iden 'fication_14 „ Personally Known .._._ OR Produced identification �
Type of ldentlflcatlon Produced lo,rLd Type of Identification Produced :Flo,' Ora hI–
Commission No.loll'14SLI91 (Seal) Commission No. CS� 2 r�r (Seal)
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Revised 07/15/2014 � � �►�n&oft Klan
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
I COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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