HomeMy WebLinkAboutBuilding Permit Application a
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: J>/ �� Permit Number:
miming rerMlil: App icamon NOV 2 9 2017
Planning and Devefopment Services PEI;:^ TTING
Building and Code Regulation Division ,LUC't ��' CcuntX. r=_
.2300 Wrginia Avenue,Fort Pierce FL 345182
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential
PERM)I APPLIC:A I IC}N FOR: To Select from dropbox, click arrow at the end of line f
PHUPOSLOIMPKUVEIVIENIILLOCA IION:
Address:
Legal Description:
Property Tax ID# // 1 � Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
Ut 1 AIL1✓L)UESCKIP I ION OF WOKK: i
G14.0f, �C "�n IVSerf C/i/+►�$G �� /oke/
CONSTRUCTION INFORMATIO.W .
Add itional work oe nArtormed under tHis perm -check 211 appy:
HVAC Gas Tank OGas Piping _Shutters Q Windows/Doors
Electric LJ Plumbing Sprinklers Generator Li Roof Roof pitch
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ ���� Utilities Sewer OSeptic Building Height:
OWNER/LESSEE: _ - CONTRACTOR: _ 1
Name r /� n� Name: GU�TtS SpntirncnS I
Address: mocJ,--- Company: Js&3?o m A +f- S u_ t eYxz hN
City; State:, Address: 15 's E T e 11 0 r
Zip Code Fax,. City: 1�0 Rt 9t- Luce State: r-y-^
Phone No. Zi p Code: s3 q5,2• Fax `77,? S-► �C�s
E-Mail: Phone No.
FIII In fee simple Title Holder on next page(If different E-Mail: u 3 t c%I r n C c►n
from the Owner listed above) State or County License: C? J I t
if value of constructlan is SZSoo or more,a RECORMD Notice of Commencement is required.
SUPPLI=M LN 1 AL CONS I RUCT ION LIEN LAW I NFVHMA 1 ION:
DESIGNERJENGINEER, _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone; Zip: Phone:
EEE SIMPLE TITLE HOLDER: Not Applicabie BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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 author' the permit holder to build the subject structure
which is in convict with any applicable Home Owners Association rules,byiaws or In' covenants that may restrict or proh-bit such
structure.Please consult with your Home Owners Association and review your deed far any restrict ons which may apply.
In consideration of the,granting of this requested permit,I do hereby agree that 1 will,in all respects,perform the work
In accordance with the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The following 4uilding permit applications are exemptfrom undergoing a full concurrency review:room additions,
accessory structures,swimming pools,fences,wails,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 reopf6ing your Notice of Commencement.
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s
Signature of owner essee/Contractor as Agent for Owner Signature of contractor/License Holder
STATE OF FLORIDA r STATE OF FLORIDA
COUNTY OF >�� U_C�J COUNTY OF ,C UC/-e•The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this—aday of /��, 20,Zby this_"day of Z�Y 20 a Py
a
eu r b s A En Mori S' (, �i r 1 y7 W1U TA S
(Name of person acknowledging) (Name of person acknowledgfng)
(Signature of Notary Public-Stite of FI a) (Signature of Notary Public-Stat of Nori
Personally Known ✓ OR Produced Identification Personally Known OR Produced Identification
Type of identification Produced Type of Identification Produced
C
Commission No. �r 5,;1 mission No. ✓ c rias�u+ .+rl 52510
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REVIEWS FRONT ZONING �! SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW { REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
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