HomeMy WebLinkAboutBuilding Permit Application • • •.
BLE • MUST BE COMPLETED FOR APPUCATION TO BE ACCEPTED
i
RECEIVED OCT 212017
Building Permit Application
. . I Development
. . Code Regulation,DIvislon
Avenue,Fort Pierce FL 34982• .,2-1578 Commercial Residential
"PLICATION FOR: To Select from dropbox,'click arrow at the end'of lin
�76Ptt „'9Cv616Jr'filo' ti •!xC@S �:.. � 57�� }
si s.p�' t; k. a : <• d^ ��yi pt,
[S:I NAM
k yr 0f �`�9 Jf :F m [t [a'la ,Myk'tt" 'NGKiF �V�'I
i.d.,r2NAtS.+Ss�.;.:min4 "t 013
�� we,rkei° � �i X111 t�;Crsua...<•�:�
Blockir
Lot No.
{. ,ont
t Side:
. iii- F p
}ryjjs7.gh yi �k .pai�'i•',I mal t Ir : `; "a `F,{5i.' f6 pt`iri' p "•[��7ji��"[q�ra'i# .••7��t t? �1;4tP` (y 'C yv- - ..�.�_ 4 y G1A is �1 d°'E }2�� l.I s��'2,-5{j�yr��'. .ti {�iys{{it tt,l!
"p ii' ,,
t3 1 }
It
mal
,j
EE
•�'p �4. � a( fir' ,f'�! 'f=����' �1:� a' .� py�•.��;,u��ij's�� b �j ,s r 3I,, 4 .�6s'
rd ai
i2El3eb 5� 1?s :i ��tttlt6ai tanEar.._ �n
ElGas Tank 0Gas Piping Shutten; Windows/Doors
. . Plumbing nSprinklers ■ s ■ `.• �..
onstrUction: SO. Ft.of First Floor:
s6 ' `�` erg a�•ryTNO
P:4'rsIf� ��s t�•�•�,.2;,1tQ,dlzL1"4^v�`°i3t�ai>�7t�� CE �G �t @ - ��r �'n6•� ads.�t�G�r�tel''€f��iW�"�,>t'� I .?Y�,4l"'is'' '`a'�a, 3
MI4Ras ��;�:
!
ak
r `a• •r r I:�1�1�
• •. Fax-
Zip Code: Fax:
e Title Holder on next page(if different lE-Mail: SIM
.;r listed above) State or County License: gf Ar j'15-10 Af7__
!0 or more,a RECORDED Notice of Commencement Is required.
Oct 23 2017 9:59AM HP Fax page 3
ESIGNERNGINEER: NotApplicable licable
� — pp 'MORTGAGE COMPANY: Not Applic ible _
Tame:
Name:
ddresS: Address:
State: City: State
ip: Phone Zip'_ Phone:
EE SIMPLE TITLE HOLDER: `Not Applicable BONDING COMPANY: —Not Applicable
ame• Name:
ddress• Address'
ity: City:
ip: Phone: Zip- Phone:
01 INIER/CO ffRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as ndicated.
I c rtify that nc work or installation has commenced prior to the issuance of a permit..
St.Lucle Count makes no representation that is granting a permit will authorize the permit holder to build the subject strL cture
wh ch is in conf let with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohi it such
str cture.Pleas consult with your Home owners Association and review your deed for any restrictions which may apply.
In i onsideration of the granting of this requested permit,I do hereby agree that I will,in all respects,perform the work
in ccordance w ith the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The following b ilding permit applications are exempt from undergoing a full concurrency review:room additions,
act essory struct ires,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential us
W RNING TC I OWNER:Your failure to Record a Notice of Commencement may result In your paying twice f r
im:)rovemeni s to your property.A Notice of Commencement must be recorded and posted on the jobsite
be lore the fir5t inspection. If you intend to obtain financing,consult with lender or an attorney before
co nirriencinkWork or recording our Notice of Commencement.
Si nature of 0 ner/Lessee/Contractor as Agent for Owner Signature of Contractor/Licenseriolder
S ATE OF FLORIDA STATE OF FLORIDA
C UNTY OF L %4 e- COUNTY OF L.L'
TI e forgoing Ir strume•t w s acknowledged before me The forgoing instrume t w s acknowledged before me
t is `o day f�� 20_1Z by thisQday of 4 G32 P—e 20-LZ by
r Ro q r L.
Name of person making statement Nari t t .
P rsonally Kn wn_ X _OR Produced Identification Personally Kno n OR Pro
Type of Identification Type of Identif r$fi= A
Notary Aublic
Pi
oduced Produced ^�;._ •sr e o 'l
,.�pavn GARYON ; .. E5�
:rte. Ne .Stale of Florida `'••,;o�ili ` GbinihisSidA
• J My C ixpiies Oct 1.3,2018 gawk n.
•' nen FF
( Ignature of otary P blFlim),r'r!national Notary Assn• (Signature of Notary Public-State of FI Ida)
Commission N 133SWO (Seal) Commission No. S'8 0 (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION . SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
Di kTE
RECEIVED
DATE
COMPLETED
Rev. 8/2/17