HomeMy WebLinkAboutBuilding Permit Application ALLAPPIJCABLEINFOMUSF BEQOMR=FOR APRJC -nONTOBEACCB71D
Date: /1'��"17 Permit Number:
Building Permit Application NOV 0 9 2017
Ranning and Development Sbrvices
Building and Cbde Regulation Division
2300 Virginia Avenue, Fort Pierce R-34982
Phone: (772)462-1553 Fax: (772)462-1578 Cbmmerdal Residential
PEFUITAPPLJCATION FOR To Select from dropbox, click arrow at the end of line
PFS IM PFC)VBVI BVT LOCATION:
Address: -1_ E /O'S - I 1 _ 1"z �� vh /I --
Legal Description:
PropertyTaxlD#: /y33 Lot No.
Site Ran Name: Block No.
Project Name:
,Setbacks Front Back: Flight Side: Left Side:
DEMI LID DELI Frit ON OF WORK:
R n �e� r�e� !o!n �✓ 9 r�.� 1� 1o��c�zl�Sff}L
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OONSrRUCTICN INFOR/IA11ON:
Additional work o be performed- under I hispermi -check 11 apply:
appy:
❑HVAC 0 Gas Tank ❑Gas Piping Shutters a Windows(Doors
❑yBectric ❑ Rumbing ❑Sprinklers ❑Generator ❑Pbof Roof pitch
Total Schl. R of Cbnstruction: SR. of First Floor:
Cost of Construction:$ '/no° ` Utilities: Sewer ❑Sbptic Building Height:
OWNS/Lean' OONTPACTOR
17
Name e o c L j I N e3 Name:
Address: 65-0 5` 4yE r%%bol `
Company: lkke5/cc rlez,a'
City: fl/ � Stater Address: )`f o . H �-m n
75p Code: 1 C0 c1 Fax: City: State: fL
Phone No. Zip Code: 3yy11 7 Fax:
E-Mail: Phone No. ? 7Z ,z1E - 221c(
Fill in fee simple Title Holder on next page( if different E-Mail:
from the Owner listed above) State or County License. I.3�%'-> E E �-2-
If
If value of construction is$2500 or more,a FECOFIDED Notice of Cbmmencement isrequired.
a PPLEM ENTAL OONSTR ET10N U ESI LAW I N A110N:
DESGNEFWENGINEER Not Applicable MORTGAGECOMPANY: Not Applicable
Name: Name:
Address: Address:
Qty: gate: City: Elate:
Zip: Phone Zip: Phone:
FEESIMPLEIITLEHOLDER Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
My.- aty:
Zip: Phone: Zip: Phone:
OWNS OONTRACTORAFRDVIT: Application is hereby made to obtain a permit to do the work and installation asindicated.
I certify that no work or installation hasoommenced prior to the issuance of a permit.
3. Lucie County makes no representation that isgranting apermit will authorize the permit holder to build the subject structure
which is in conflict with any applicable Home Owners AssDaation rules, bylawsor and covenantsthat may restrict or prohibit such
structure. Please consult with your Home Owners Associat ion and review your deed for any restrictionswhich 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 Bjilding Codes and 3. 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 usesto 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 Cbmmencement 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.
�J
9gnatu of /Contractor as Agent for Owner Signature r cense Holder
STATE OF FLORI DA STATFz OF RJOR D "
COUNTYOF �• :�_ LL L( t' COUNTY
The forgoing instrument wasacknowled before me The f ing instrum t was acknowledged before me
this day of 20n by this�dayof 20� by
r
1 � l
Name of perso making statement e of person m ng statement /
Personally Known OR Produced Identification Personally Known OR Produced Identification v
Type of Ide if' J a Type of Identification
Produced '15`Z�$ � (C�� 1 31 Produced Cent � 5 2?n
C oEY D FIK
(99nature of t lic-State of Rorida) c site or Florid. (Signature of ar �'''6160da.)Expires Dec 1,201;
�n xpires Dec 1,2017 ", F a� Cc icn u FF 0069924
Commission No. t l f �� Bond=. )
Co on#FF 669924 Commission r 9'al !Na As;
- Bonded Through National Notary As,
REVIEWS FRCNr ZIDNING SJPEFM9DR PLANS VB3L7A-nON gA1URTLE MANGFOVE
ODUNTER REVIEW REVIEW REVIEW REVIEW REVI BN REVIEW
DATE
FEC8 V®
DATE
COM PLET®
Fbv. 8/2/17