HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ( I 'S I Permit Number: \_)i
Building Permit App
g RECEIVE®
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Planning and Development Services
Building and Code Regulation Division NOV 0 3 2017
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772)462-1578 Commercial RPeijl mJ
PERMIT APPLICATION FOR: F-St. Lucie CuuntYr FL
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PROPOSE[? INPROUEMENT LOCATION. _ rzdn
Address: 571 96 4� NWONJ DRIVEa FT FIEk(f 34961
Legal Description:I�/��POG PQ�K l}nl� I( , ��K I3g -(,j �39
Property Tax ID#: 1301'613-0063-000_9 Lot No. 1�
Site Plan Name: Block No. 139
Project Name:
Setbacks Front Back: Right Side: Left Side:
QEl"AILED DESCRIPTION OF WORK Pi, , ' 7t � E
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CONSTRUCTION INFORMATION tit'7f, "� rt � �
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Additional work to be performed under this permit-check a tat appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator ;'X Roof 1/ Pitch
Total Sq. Ft of Construction: 32D6) Sq. Ft. of First Floor: I
Cost of Construction: $ .10(; -00 Utilities: —Sewer —Septic Building Height:
F
.40 EEM k* tl tJiYatr .,14�
GONTRACI'OR � �a 4
Name: L61 re M110
`Adtlrress': j)�`�' Sl�QNI'iU01Vg: Company: �� � �ile -1'C.
City: � .�,. �� :.,.�,. ,. State:�� Address: p C� I Q lq -
Zi Code: c -
p-- 34��JI City: Stater
Phone No. 772 46-5 0190 Zip Code: 479 Fax:
E-Mail: Phone No 772 9 �
Fill in fee simple Title Holder on next page ( if different - E-Mail a-WGe r' bellh'h' fie"
from the Owner listed above) State or County License Ci 12007q
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
� 1��( 1� 1iII� C3NSTRUCTN LII=N LAW INFORMATION {'
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
Cityy:., State:_ State: City: State:
�Pl orie; ' .y Zip: Phone:
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FEE SIMPLE TITLE HOLDER: I Not Applicable BONDING COMPANY: Not Applicable
Name: z Name:
i`', .Yt"l s
Address: Address:
City::( 3_ ;+:'. i° City:
Zip: _ �1P,hone: 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
commencing work or recording our Notice of Commencement.
Signature of wner/Lessee ractor as Agent for Owner Signa urefContractor License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S k l.N�c R. COUNTY OF LVcI e.
The forgoing instrume t was acknowledged before me The forgoing instrument was acknowledged before me
this day of i�l6lI 20� by this day of NC)Veyn6(Z 20 by
(Name of person acknowledging (Name Pers acknowle ging)
(Signature of Notary Pu c-State of Florida) (Sign re of otary Public-State of Florida )
Personally Known OR Prq ,cgdl Personally Known
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Type of Identific p�ANNAMARIEGiVENs 7� j Type of Identification :��;a�pfB,,,, TIFFANY FORGET
Produced k€ '^�`: OfiftA�ISSION#GGO7.20_ Ily Produced =r• • No TIFFANY
Public-State of Flori a
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EXPIRES:December 16,2020 s; ; My Comm.Expires Sep 29,20111
ed Thin NO ,PUb 1 Undem�riters 1 o
Commission No. �4 � ;.; Commission No. �2 •'Foo �' (Sngd, ission#FF 129988
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