HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED (�
Date: /%D�',Z , 7_/-7 Permit Number:
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Building Permit Application
Planning and Development Services NOV U 2 2017
Building and Code Regulation Division PER"Al1Tl vG
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Resider 49f 1e cam''"tY, FL.
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
P _ .S P&MOVEM,ENT,LOCATION:
Address:
Legal Description: 'ojypoGC QXrI-ult t�/D- $/� 2� 0'iL/a
Property Tax ID#: /301 —to I Z - 01741—P41:9 Lot No.
Site Plan Name: �' G tt. vd5 Block No.11d�
Project Name: //;CKS r S
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION:
Additional work toe e orme under this permit-check a app y:
HVAC 11 Gas Tank Gas Piping Shutters ❑Windows/Doors
11 Electric ❑Plumbing Sprinklers ❑Generator Roof Roof pitch
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction: $ ��. Utilities Septic Building Height:
OWNER/LESSEE: CONTRACTOR
16
NameEj�LlY L & Name:
Address:6ZEZZ W P X 21014 001! 1 Company: Y r i'c-a A lf
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City: O� I Q G`� State:j5/, Address:3 Od A
Zip Code:-3 1 L75Z Fax: City: Ed d pl f rnr _ State: �
Phone No. (p 3/• 43 Z-- • 3702 Zip Code: 3 4 Q 51 Fax:7 7Z 7q�-l S9d
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-MaillJAA ii
from the Owner listed above) State or County License: �{
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW 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: 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 thepermit 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.
Signature f Owner/Lessee/Contractor as Agent for Owner Signature f Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ,�, . ` I1C.I(r• COUNTY OF
The forgoing instrum nt w s acknowledged before me The forgoing instrume t was acknowledged efore me
this day of 20 by this day of &16V 20a by
Name of person rpaking statement Name of person making statement
Personally Known ✓ OR Produced Identification Personally Known V OR Produced Identification
Type of Identification Type of Identification
Produced Produced
t OAA
(Signature of Notary Publi ignature of Notary Public-State of Florida)
a�> KAREN S. NIELSEN
Cpl ssion p FF 115637 Y'i
REN S. SEN
Commission No. :. ) mmission No.
Y Commission Expires Commission # FF 1 15637
June 12, 2018 M Commi
•�""""`� Y ssion Expires
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MA G OVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17