HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED a
Date: Permit Number:ql�w
RECEIVED
Building Permit Applicati � n
Planning and Development Services NOV 13 2017
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 Permitting Department
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Phone: (772)462-1553 Fax: (772)462-1578 Commercial % icLer9�'r*Z, O(Ntyr FL
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line q add
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Address: 7 JLQ
Legal Description: LA146-too �- fjL ;�-
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Property Tax ID#: 13 101 - 01 - C91 $a 000 `/ Lot No.
Site Plan Name: Block No.
Project Name:.
Setbacks Front Back: Right Side: Left Side:
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Additional work tonasTank
orme under this permit—check a appy:
HVAC ❑Gas Piping _11-Shutters Windows/Doors
11 Electric 0 Plumbing Sprinklers I Generator Roof Roof pitch
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction:$ 1 �� Utilities:CnSewer Septic Building Height:
OWNElJ�ESS �CC�NTRACTOR 3
Name 1A/lLL1411k PDV LlT'L. Name: E ,LIY
Address: -1SD3 Phtyolml Company: boott4 kyp4'e- DC-
City: BE &9-9-e- State:�L Address: 37 S
Zip Code: J Lt(.5_1 Fax: City: , D � State: F—f—
Phone No. '77 a " q SQ — 3151 Zip Code: 3 Y 9 L/S Fax ?7 Yl?33
E-Mail: Phone No. 77 VD — `
Fill in fee simple Title Holder on next page(if different E-Mail: dzeaah tQoors c!/ dmore , Cd011
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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 Count makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in contlict 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.
N. �tl�
Signature of Owner/Lessee Contractor as Agent for Owner Signat-rd of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTYOF !;-\r, COUNTYOF S-r.
The forgoing instr ment was acknowledged before me The forgoing instrument was acknowledged before me
this L3 day ofV dJ 201 by this A% day of 20VVL by
Name of person making statement Name of person making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Ident
jfication
Produced Produced N 1- 'Q L..
pEANNAMPRIE GNENS
v'••, GG 0220 3
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(Signature of Notary P lic- tie F}rt3rida plREs:Uecember 16.202 �S nature of Nota -
Gt' onded Thru Notary Public Unden+ te' .�.+ow°;� DEANNA h1ARlt GIVENS
Commission No. �` ... Commission No. s MYCOUI.rvtlSJJ196gITG022023
a: �XPIRES: camber 16,2020
•'`•;,y;;�` Bended Thru Nofary Public Undenv liters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17