HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: .6 �'� Permit Number:T1 \
Building Permit APPH
,CEIVE®
Planning and Development services -OCT 8 0 2017
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 n g Department
Phone: (772)462-1553 Fax: (772)462-1578 Commercial R� �u�llFI_
PERMIT APPLICATION FOR:
PROPOSED.INPROVEMENT;LOCATIC IU:.a
Address: 2 14'
Le al Descri tion: 3 - 5 0 co roO [� ey 0 hJ S
g p ��! � �-r� r� 1 Lf --
Property Tax ID#: E?.`s'� _ Sr b ` O o/Z-Y- -C-0a 0 57 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION CJF WORK
CONSTRUCTIONIWORMATION
Additional work to a pertormed un er t is permit-ch-e-cR all that appy:
—Mechanical _Gas Tank Gas Piping _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
TotalSq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $^ Utilities: —Sewer _Septic Building Height:
C3Vtf N ER%LESSEE,
CQNTRACTOR.,e
Name tQ, y tr-� f, I. e 2, 11''l.,L C. Name:
Address: tG; P17 Company:
City:fir'i &rc-c State: �L Address: to c, 4 _ r_
Zip Code:.3 Li Fax: //�� City: S' L;1 C-1\r_ State: i`c-
Phone No.7? 2 41 �i �� 2 Zip Code: 1 Fax:
E-Mail: Phone No 1-1 -c
Fill in fee simple Title Holder on next page(if different E-Mail , s-; �� y i%r Se!Vle C"C c"',Fr u-.-'C�M,
from the Owner listed above) State or County License Ce'-t-:?o l�-r
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CC?NSTRUGTI.ON .�EN LAW lrl�IfJRItiIIATI(QN .9
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address:.___.. __. Address:
City-, z:, = - :� ! State: City: State:
Zip: t ;y. Phone'_ .asp I Zip: Phone:
FEE SIMPLE TITLE,HOLDER: ; Not Applicable BONDING COMPANY: _Not Applicable
Name: I' F' Name:
Address:,. Address:
City. ;.. w: City:
Zip:` i-- Phon`e'. s c; 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 herebVagree that I will,in all;r'espects, 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.
Signature o Owner/Le a/Contractor as Agent for Owner S.ijinati.Kre of Contractor/ ' ense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF GA-, L" COUNTY OF S k, 2
The forgoing instrument was acknowledggd before me The forgoing instrument was acknowledged before me
this-2-6 day of_-_Oc_-t 2011l by this'!nb day of 6 c.�v 204 by
�,d✓vJ z+.S c� J yYt -'7 Y` A Nod. r d� IJ�M\
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Nota Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification ,�
Produced L l., R G�vENs 1 Produced t- .,r�, nFANNAMARIEGtVENS-
GG D?2023 _ _;, .,e..••y-:
COMMISSION# X00 = MY COMPdISSION#GG-02.2�02�3
Commission No. ro- MY IRES: ��ef�°'2'` ters Commission No.
EXPIRE5:L7
_ _ P too t rs
od}hn�Notary publicUnden�n 'FBF F`oP- Bonded Thn+tlo ry u .c Undens ri
Bonde
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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