HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �a13d`11 Permit Number: �1 fid' d15�
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Building Permit Appli CEIVED
Planning and Development Services
Building and Code Regulation Division OCT 3 0 2017
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial &Sp Inga artment
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PERMIT APPLICATION FOR:
PR;00E0IN;PROVEMEIVTIILOCATIdN
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Address: t - (z-
Legal
Legal Description:
Property Tax ID#: �� 5J,d�, O aCi� - ��10 Co Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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DETAILED DESCRIPTION OF WORK ;i
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CUNST.RllCTIQN IN:.FORMATIONu
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Additional work to be pertormed 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:$ � - 00 Utilities: —Sewer —Septic Building Height:
OWNER/LESSEE CONTRACTOR
Name Name: 'L o
Address: �`� C� ��f Company: ' ��� �� 1
City: State: Address: l.� CFV)
Zip Code: 3 'g Z�( Fax: City: Stater
Phone No. Zip Code: 3"f 9 ��f Fax:
E-Mail: Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License Ria 11Z 3
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SU,PPIEMENTAE.CONSTRUCTION !:{ N LAIN INFORMATION.
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:' I City:
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
commgaqng work or recording our Notice of Commenceme .
2Sig ure of Owner/Les ontractor as Agent for Owner Si ture of Contractor/L' older
STATE OF FLORI STATE OF FLORID
COUNTY OF COUNTY OF 5 Ir
The forg3ooing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of a cAb2031 by this S6 day of ave 20a by
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identifi&ation Type of Identification
Produced Produced
DEANNAMARIE GIVEN
S
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o, Nofia blit-8t>�31�i
(Signature of Nota P Cate tafQEi�^ mber�i202�01 (Signature �,
" of F�°:' Bonded Thru Notap public f `"' �''- MY COM #'(�O '2
023
5+R?
Commission No ° = Decemberl neo
Commission ir:_ �rypublic �ars
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 812117