HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 16 - )� � Permit Number: ��l I _0 G�
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RECEIVED
Building Permit Application
Planning and Development Services OCT 2 6 2017
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 Permitting Department
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Rjtsiq j I
PERMIT APPLICATION FOR: ;C
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PRC}POSED 11PR01lEMENT LaCATION
Address: c�S
Legal Description:
Property Tax ID#: 5 �� 5 dd� 6®a Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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CC7N5TRt1CTitN1NFORl�/IATION � 0
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Additionalworkto a per orme under this permit-check
all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
1 lectric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ / 0n Utilities: —Sewer _Septic Building Height:
011VNEIjLESSE: COtUTRAGTOR.
ra ۥ. X01 oa
Name 1 �Y� ir-e,� Name:
Address: C. t Com H. rico e_ J11 e l•-te
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City: Se, l=- ae k StateFy-- Address: �f56 G ) ( tc►�.or-- ! �
Zip Code: Fax: City: Statef-
Phone No.-7'7.�-- n90 Zip Code:aq!!23 J Fax:
E-Mail: Phone No G(- S7W
Fill in fee simple Title Holder on next page(if different E-Mail ,4-e.e e.GLr('c-(bl
from the Owner listed above). State or County License r e!�- 1-30C)61"
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SLIp�LEI11iEfTELCC}NS�` T10N INA1NNRMATttN.
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:: i 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.
,
�\ VaturZ:er/Lesse ntractor as Agent for Owner Sig to f Contra r/Lic rise Holder
STATEIDA A OF FLORIDA
COUNTY OF 5�-_ \--\)c % e COUNTY OF 5 -_. l. �c%e
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this J4 day of (:1c_) 2011 by this a% day of 204 by
Name of person making stateme t. Name of person making statem nt.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced INA— cProduced Vv� t D
(Signature of Notary - V GGG22G23 S (Signature of Notar -
P Y MY�p�gJI1SS10 tuber 16,202G 1 R�F DEAiVNA MARiE GIVENS
Commission No. 1�C ,. .!. :: PIR tars
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4o��Publ�cUn Commission No.l. 1t�' oMra�IssroN�g���G�3
1%;? gondedlhnr i ;o
EXPIRES:Decem er 02G
GP Ft�P Bonded Thru Notary Public Undervmteir
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Te—v. 8/2/17