HomeMy WebLinkAboutBuilding Permit Application (3) i ,
AIIIAPPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED t/
Date: Permit Number: 1 !1 " 0��7
Building Permit Application !
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 I i
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential r/
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PERMIT APPLICATION FOR:
P'R®PDSED IN�R�R,0�1/E(�/I,ENT rrL11O''CAT .aN: ` Y�
Address:6�Oe�2_G;
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Legal Description:_ �'6�/C: �o9 , �,a .
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Property Tax ID#: `jom L Z Lot No.
Site Plan Name: Block No.
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Project Name: 40/-,, /' S
Setbacks Front Back: Right Side: Left Side: !,;. !
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DETAI'I_ED DESCR{l'PTIQN 0'F WORK:
C®NSTRUCTtON I'N:--ij MATIN:
Additional work to be pertormed under this permit—check all that appy: I`
_Mechanical _Gas Tank —Gas Piping _Shutters Windows/Doors
_Electric _Plumbing _Sprinklers _Generator I' Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
oa
Cost of Construction: $ ���Z�r Utilities: —Sewer —Septic pBuilding Height:
WI E /LESS E: C®NTRAC1`QR�.
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Name ^ v c�_ s Name• I i-
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Address:4WD4 /��G i / e Company:a e
;City: Ac-f 2?L Zee Ci State: ,?Address: ZZ��11 //,ISS ` n ►' 4_1
Zip Coder - o
-S Fax: City /`4 JTL1crr ,6� State: � r
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Phone No. 77Z—�j L 2 42 Zip Code:34 `j.Sr Z_' Fax:
E-Mail: Phone NQ 7 2-
Fill
Fill in fee simple Title Holder on next page( if different E-Mail (
from the Owner listed above) State or County Lilc nseC`_"G(',1 oon 9 3
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. ,
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SUPPLEMENTM111NSTRCI:C�TC®N LIE:IU LAW INFORMATION.
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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 County makes no representation that is granting a permit will authorize the permit 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`]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/Contract/ as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDAST. Zr
COUNTY OF , COUNTY OF
The forgoing instrum. ggnt was acknowledged before me The forgo* g instru��eff��t was cknowledged before me
this day of !v� ✓ 20Z by this M of Matlerat er 2017 by
9,1 AAAAM4A Awwco /<. /;W.
(Name of person acknowledging) (Name of person ac nowledging)
gna%ture of Notary Public-State of Florida) (S' natur of Notary Public-State of Florida ) /
Personally Known OR Produced Identificatio•- Per ovally Known OR Produced Identification Y
Type of Identification � AHi1Ak.GRo�Ft Jype of Identi�ation
Produced �' i�poblic State aZ 19 Produced 2 JANNETTE M.PERI.mum
'0a Notary Public,State of Florida
�Pµv c i NOtat� [YPi«S .DaB', ��� n
Commission No. ' ?=`ry MY(5�a n _ I "s'•Commission No. �S@t h fission#FF 173539
Asn AY comm.expires Nov.15,201
,•ar 'ate°�ond�.Vn���:-•
REVIEWS FRdl-
COUNTER
NT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014