HomeMy WebLinkAboutBuilding Permit Application All APPLICABL INFO UST.BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
4 P
Building Permit Application
Planning and Development Services
!Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
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!PERMIT APPLICATION FOR:
APROP, SED INPROVEMENT LOCATION F
1'
Address:
Legal Description: �' U`11` a �� QYLS 3 ! 2
; G -
tl $
Property Tax ID#: 2 L��Jr ��Z I Lot No. 2—
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAIL D DESCRIPTION t3F WORK
CONSTR,UCTICIN IiVFORMAiON
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Additionalwork to be performed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping. _Shutters _Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
OA-
Total Sq. Ft of Construction: Sq. Ft. of-First Floor: '
Cost of Construction: $ 24 NJ Utilities: —Sewer _Septic Building Height:
(311UNERJLESS,EE. CONTRACTOR
Name L.L.C. 'VfG5k1qr Name: .-T- B A-4i CC6—,<
Address• 17-flI Company:
City: ` C9�t2L State Address:&��e4A11�-�,�i¢Ci i
Zip Code:�59 f S Fax: City:. Sr��i State:
Phone No - ( Zip Coder Fax: 4�
E-Mail: 1:1-6)� Phone No 772"?,3z1-
Fill in fee simple Title Holder on next.page(if different E-Mail ��9Jl�cIL��! � � e'::��/LA .
from the Owner listed above) State or County License C��--5O&17 33 46
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CQNSTRUCTION LIEN LAW INFORIVIATIDN
DESIGNER/ENGINEER:/ Not Applicable— pp 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.
Signatur o Owner a ee/C &tractor as Agent for Owner Signa re ,f Co vIgbor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY-01 c, C COUNTY OF.
The forgoing instru. ent was acknowledged before me The forg ng instrument was acknowledged before me
this "day of �✓s��/ 2017 by this nay of Ag is niv* 20j_7 by
(Name of person acknowledging) (Name of person acknowledging)
(Signatur u lic-State of Florida) ature o otary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced ")✓deJ Produced of ) &..j
BRE SP®tSI
N SCARLi5TT e��: �I�CNDAN SGARLETT
Commission No. P MY CelvliVON#FF960076 Commission No. : . MY COf ��ION#FF960076
EXPIRES February 11.2020 T?a:i; EXPIRES February 11,2020
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.-