HomeMy WebLinkAboutBuilding Permit Application ;K
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 11 13 1 Permit Number: 12R
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Building Permit Application
Planning and Development Services NOV U 6 2017
Building and Code Regulation Division PER"hIl-TING
2300 Virginia Avenue,Fort Pierce FL 34982 5 . Lucie COUnty, FL
Phone:(772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPIICATION FOR: To Select from dropbox, click arrow at the end of lineAwl
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Address:
Legal Description:
Property Tax ID#: S+0 a D00' S Lot No.
Site Plan Name: Block No. 2 9
Project Name:
Setbacks Front Back: Right Side: Left Side:
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TionAC a wor to e e Forme un er is permit—c ec a appy:
VGas Tank E]Gas Piping _Shutters Q Windows/Doors
11 Electric Plumbing Sprinklers FIGenerator Roof Roof pitch
Total Sq. Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ 13"/�100 .�� Utilities Sewer F]Septic Building Height:
Name Name: SJJ MLt(fA ll,.�A r n�
Address:5IS0� (, 4W Company: -Add r1-I-a0fe- W P_
City: 4 pfe rcp_ State: t�j Address: (0 D1 S- 1qi r E P4 niff,
Zip Code: Fax:_N City: 1pr Pwae— ^Stater
Phone No. n 2- Sa S- bOG1.4 Zip Code: '� 2 Fax: !�Yp M415
E-Mail: N1 'A Phone No.__n'S - 4,45 I(QW
Fill in feesimple Title Holder on next page(if different E-Mail: `
from the Owner listed above) State or County License: 0
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER ENGINEER: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City. State: City: State:
Zip: Phone: Zip: Phone:
FEE SUMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name. Name:
Address: Address:
City: City:
Zip: Phone: Zip: Rhone:
!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:Yo;iar failure to Record a Notice of Commencement may result in your paying trice 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.
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Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF a LOssMA
si COUNT'OF br. 4/0"R COUNTY OF 'e
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 by this day of 20 by
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(Name of person acknowledging t \yoo`��e FINE E:C' y/rte_ (Name of person acknowledgin �.� N''�F Cq fsd�
qa .Gp�aM,ISS/p��9��''-c '�OMMISS�.,Car
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Personally Known. ✓ OR Prodio Kben-ca��a°," Personally Known ORI
Type of Identification Produced °���' ''��`::e''=�''cr Type of Identification Produced
CommissionNo. A�F (Seal""5 Commission No. (Seal)
Il Revised O�f/1-'V2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION -SEA TURTLE MANGRO%
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
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COMPLETE
! INITIALS