HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED.
Date: %0 "'S� 1. 1�, Permit Number:
RETEUVED
M. .. _... Building Permit Appli ation
OCT 31 2017
Planning and Development Services
Building and Code Regulation Division Permitting De artment
2300 Virginia Avenue, Fort Pierce FL 34982 1e lJ my,, FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial este
.PERMIT APPLICATION FOR: .�.��
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PRC}PC*SEDTINPtQVEMENT LQCATION.
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Address: � t
Legal Description:
PropertyTaxlD#: �3������J� dd3�-c�c�o -� Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK.
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CONSTRUCTION INFORMATION
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Additional wor to be performed 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 Construc6ion: '� I 1 Sq. Ft. of First Floor: 3
Cost of Construction:$ '— ` LJA.J Utilities: Sewer _Septic Building Height:
C3IIVNER/ SSEE.
CP RA
Name Kmidn, LA Name:
Address: 1 Company:
City: L'I State: Address:
Zip Code: 3Qi ( Fax: City: State:
Phone No Zip Code: Fax:
E-Mail: Mone No
Fill in fee simple Ti&Holder on next page(i different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLENiENTALCONSTRUCTIQN LIEN LAW tNFC}R1IJIATlQN
DESIGNER/ENGINEER: _^Not Applicable MORTGAGE COMPANY: _ Not Applicable
Name:
Address. Address:
City:: State: :r.: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLE TITLE HOLDER: I Not Applicable BONDING COMPANY: Not Applicable
Narrie:^ r, 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 posted on the jobsite
before the first inspection. If you intend to obtain financing, consult with lender or.an attorney before
commencin ork or recordingour Notice of Commencement.
Signature of ner/Lessee/Contractor as Agent for er Signature of Contractor/License Holder
STATE OF FLO I A STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowled ed before me The forgoing instrument was acknowledged before me
this 3\ day of ne-A ,20 7 by this day of 20_ by
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(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary P lic-State of Florida) (Signature of Notary Public-State of Florida )
Personally Known OR Produced Identification _. _ Personally Known OR Produced Identification
Type of Identification ype of Identification
Producedt- %0maGG, 0T3 roduced
DCN SS%0N4 2o2d
Commission No. L �(.5 r� `;'. ( Ft� ES DFublwV"den , .s
�= tao�ry mmission No. (Seal)
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REVIEWS FRONT ONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014