HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ' d oL Permit Number:
CEIVE
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BuildingPermit A I� on
p
Planning and Development Services OCT 2 4 2017
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982 De a ent
per��in p
Phone: (772)462-1553 Fax: (772)462-1578 Commercial R I FL
PERMIT APPLICATION FOR: vvC,?,
PROP17#EDttVftOVEMFNT LOCATIGtV
Address: 401 A rS� �� � l'?,'r �
Legal Description:
Property Tax ID#: '�"�dv1' �Ol. 1;co (3do--a Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back:' Right Side: Left Side:
,DETAILED.DESCRIPTION ( F WQRK.
21 W
A�
CC►NSTRUCTICEN 1NFORMA_ Tl0'N
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Additionalwork to ape orme under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ V0 Utilities: —Sewer —Septic Building Height:
01NNER/LESSEE• yCQNTRACTOR Ma,,
w .
Name f Name: 6
Address: of Company::_
City: Ark `Pierce State:_ Address:
Zip Code: 5garZ Fax: City: X41 e-I Stater
Phone No. 6W - 2 /,s -14-- Zip Code: !3qL?12 Fax:
E-Mail Q � e C-4--ko Q a rnK;) • C001 Phone No • 5-4
Fill in fee simple fjitle Holder on next page(if different E-Mail 0- OJ CeI09
from the Owner listed above) State or County License CIS O
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
'77777 7
S,UPP�:EMENTAL CONSTRUCTION IIEN,LAW INFQ`RMATCt3N
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 postegPolqlthe jobsite
before the first inspection. If you intend to obtain financing, consult with lender or an or dy before
commencing,wgrk or recoding our Notice of Commencement.
Signature Own r/Lessee/Contractor as Agent for Owner Signature of Co rarA
nse Holder
STATE OF FLORIDA _STATE OF FLORICOUNTY OF 5 1.yc•t COUNTYOF 5 `I\_"-
The forgoing instrument was acknowledge before me The forgoing instrument was acknowledged before me
this day of �C-fi 2011 by this_day of ZSR 20L)_ by.
Co1���
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary P lic-State of Florida) (Signature of Notary P lic-State of Florida)
4Y AVJ'• 75YM'1t
Personally Known OR Produced Identification Personally Know _,,:a••••. =AR PrB �fin X`77 ipn t
Type of Identification Type of Identifica 711 i* MY COMMISSION# 0?1 23 !
Produced V � "—' :a5 EXPIRES:December 16,2020 f
Produced :SjE�r���c ended N�}nqFublictJniienrtss
... D.1 NAMARIEGiVENS
`'q MY COb MISSION 4 GG 0?2023
Commission No. - PIR,S�)rmber16,2020 Commission No. (Seal)
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014