HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED q
Date: Permit Number: �1 ��- G V 1a
_ Building Permit Applica ECEIVED
Planning and Development Services
Building and Code Regulation Division NOV 2017
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Re %QlWnOwartment
PERMIT APPLICATION FOR: cue @ Oun y,
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PROPOSED N`PR01/EMRN1TJLOCATIUN
Address: -Z-FOS L4 tL E L ✓1 VC VD
Legal Description:
Property Tax ID#: 11S 6N- \a - CsC)y% 680-5 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DEQ-S�'C t1PTlON C�?F WOR
D Ue-2 I1rAQ 10 011389C,60-6014,0 '-PPL LLE,"TI- 1-1_ sl RR_Ur 11�_
CON) V t�6z::()-tJ
CONSTR�UCTlON IN'FOR ATlON:
Additional work to be pertormecl under this permit-check all that appy:
_Mechanical _Gas.Tank _Gas Piping, _Shutters _Windows/Doors .
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
(XrCost of Construction:$ -7 Utilities: —Sewer —Septic Building Height:
OWNER/LE=�SE• CONTRAaR:
Name A--[T-1+E t EAY,-eName: -
Address: L-Up B(_t)0• Company:
City: Fd T. P,'eQC-F_ State:EL, Address:
Zip Code: 3 Fax: , City: State:
Phone No. S nilr_ ?1 G/ b -Zip Code: Fax:
E-Mail: g PV-t F_ A46-1-rV_, A17,N tT- Phone No
Fill in fee simple Title.Holder on next page(if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
S IPPLEMENTAL CQNSTR+UCTION LI �N LAW IMFORMAT1aN:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City:- State: City: State:
�ZIp: g Phone Zip: Phone:
FEE SIMPLE TITLE HO*LDER:''' _Not Applicable BONDING COMPANY: Not Applicable
Name:
Address:" "` I Address:
City.: City:
Zip: ' ' Ph'on'e'_: 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.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this 1 day ofy , 20I7 by this day of 20_ by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Nota ublic-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
,,,t�4o;•,,
DEANNA MARIE GIVEN
Commission No. ��I�COMMISf�fQh�#�GG07.2023 Commission No. Seal
-
EXPIRES:decem r 16,2020
Bonded Thru 140tzry public Undenvdlers
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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