HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: /_7/ 0-0-M�7
Building Permit Application
Planning and Development Services OCT 31 2017
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: Plumbing
PROPOSED fNIPf20VEMENT LOCATION
Address: 8 3 19 c P L -
Legal Description: 119 a
Property Tax ID#: 3AB _ 7V r�f)q "6o r y Lot No._�
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED SCRIPTION
DEOF WORK ;
1Q.Qa'V &V)4 { -5o ak Q ' ck�c uua4e"e- h"ke'
CONSTRUCTION'iNFORIVIATIQ`N
Additional work to be Der orme un er t is permit—c ec 11 all a app y:
HVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
11ElectricO Plurnbing Sprinklers F!Generator �Roof Roof pitch
Total Sq.Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: Sewer _Septic Building Height:
0W7NER/LESSEE CONTRACTOR:
Name C} t Name:
Address: 6 {�, Company:
City: A yA S WC l State:_F�— Address: i
Zip Code: 31Fax: City:,�E�a- �-ttx c State: FL.
Phone No. 77f2 �7 O i/9010 Zip Code: . -C O D . Fax:
E-Mail: Phone No. :12c2, :--?77— VVJp
Fill in fee simple Title Holder on next page(if different E-Mail: I h1V\C "�p o- L_C�
from the Owner listed above) State or County Licenser
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL C(JNSTR.UGTI:ON LIEN LAIN I;NFO;RMATION
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Ad d ress: Ad d ress:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLEHOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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.
s
Signatur of Owner/Lessee/Contractor as Agent for Owner Sig7,—ure Contractor/License Holder
STATE OF FLORIDA STFLOR14
COUNTY OF S+ e COUNTY OF -� I 'u'e
The forgoing instr m nt was acknowledged b fore me The forgoing instrument was acknowledged before me
this day of.m1:1121, 20 J Zy this .7/ day of 20 0 by
(Name of perso nowledging) (Name of person ac edging)
(Si atuye of Notary Public- of Florida ) (Signa of Notary Public-Sta lorida)
Personally Known OR uced Identification Personally Known �.ed "ilqgmega
Type of Identification Produ Lr<k Nemo 1 Type of Identification Prod ��
Commission fGG101442
Ex es:May 4,2021
Commission No. 'sc (Seftires:May 4,2021 Commission No. i
th,�Aaron Notary
Bunged thru Aaron Notary
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
f� -INITIALS