HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFORM ST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: d l 7 Permit Number:
OCT 2'0 2017
M7 Ml -—Mlff rl
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue -Fort-PierceFL`34982---
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR:
211
Address: (ox a o , dna -ok– ` err/-- (orf°s�� R_ T T7 Z3 ,
Legal Description: 1�M''tr&A fry 4(k �+-c` ` 0°a-_ /14�0,c (083"30
Property Tax ID#: 7OS-- 000— Lot No.
.:�Rz
Site Plan Name: Block No._1,
Project Name: e c <<
Setbacks Front Back: Right Side: Left Side:
:� SA�M!�
IFFWtisermit–c ec a t at app y:itiona wor to a pe
_Mechanical _Gas Tank _Gas Piping_ _Shutters _��WindowWindows/Doors
Electric _Plumbing _Sprinklers _Generator 1,_ of 6111 ` itch
Total Sq. Ft of Construction: 300 Sq. Ft.of First Floor:
Cost of Construction:$ C (7 4C)0. dO Utilities: _Sewer _Septic Building Height: 1
Name Name: 1,4ke
Address: Company: ^C•
City: 0 o - Ae State: Address:
Zip Code: 3 14 !s�.a Fax: City: State:
Phone No. :221ill, W-3 Zip Code: Fax:
E-Mail: Phone'No
Fill in fee simple Title Holder on next page(if different E-Mail 7t
from the Owner listed above) - ' • State or County-License_ L
_ �}•�..,. .i�rF.":�_if.:vi. �i�':. _ ,`i'yti. }•' � _i 4iVie<.�.:.;sY?.
If value of construction-is 1 00 or more ,i°RECORD.ED;Notice of Commencement ii46Fc dirLh&,,�•; _ :-f. -. '' `v,..
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.
Si ature o wrier/ essee/Contractor as A r Owner Signature of C actor/License Holder
STATE OF FLORIDA �}-� � _ FLORIDA
COUNTY OF g J COUNTY OF1
The forg ' g instrument wa acknowledged before me The forgot g instrument^wa�s acknowledged before me
this ay of 261_1 by thisof ,20 f7by
(X
(Na of person ackno ledging) (Name f person acknowledging_ Vah d� )
)
.(Signature of No ary Public- ate of Florida) (Signature ofotary Public Sta a of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE. MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW- REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLET
ev. a;lr K .'
COMMISSION#GG107538 ::: MY COMMISSION#GG107538
EXPIRES May 23.2021EXPIRES May 23.2021