HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �J
Date: J� 7 • 17 Permit Number: C7
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Building Permit Application DEC / 4 2017
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 K
PERMIT APPLICATION FOR:
Address Id-1 Sc �� ��q��ne
Legal Description: _Nycr furl_-Unik-1 1611' 11 SOT aa.(VY\CLP
Property Tax ID#: ��-5 -p\LIS''GOI:O-3 Lot No.
Site Plan Name: \J Block No.
Project Name: 1A
Setbacks Front Back: Right Side: Left Side:
To tear off Ccs�SAlna Trac& ahc\ Cv\sral\ flew 30 Slt Arr'n S liyxilef'.
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Additionalwork to be pertormea uncler this permit-clieck all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator Roof
Total Sq. Ft of Construction: 1100 Sq. Ft.of First Floor:
Cost of Construction:$ 230ic-"so Utilities: —Sewer —Septic Building Height:
I
ame �4snnO Cyiasc_ Name: Qic"1rck W1TyaclinU.(L
ddress: 10-1 Src PICACaQ Ci- Company: AVXA�J A-he PM06ex 4 (10
City: 2Dd "Min-V Lade State:_1- Address: 4LQWa S6 CCilae Eyx m k0e_
Zip Code: 344 tJR 3 Fax: P A City: ?DYt Sdin.f Lu c_ie State:
Phone No.-1'1',J-agll-y'1'19 Zip Code: !3(4Qc� Fax: PIA
E-Mail: H IN Phone No
Fill in fee simple Title Holder on next page(if different E-Mail Y(t.hieu+rnrhr,,.V_Q Sky 4il.c•0hr
from the Owner listed above) State or County License a` 4t o-1
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: _ -- -
_ -------- State:- -- - -=-
State: -
-- - Zip. - Phone - City: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 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 f Signature of Contractor/License Holder
STATE OF FLORPA STATE OF FLORIDAC'l1 ,A C, • a rn">.
COUNTY OF Ij-I/>•C 1 e o m< COUNTY OF J,7-- """' I �
2 m�n �micz
The forgoing instrument was acknowledged befor ��-c The forgoing instrument was acknowledged beforez�
this ,day of" - D P C_ . ,20 11? by w o= this day of P C . 1201 7 by �T
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Name of person making statement. .mN Name of person making statement.
Personally Known L/ OR Produced Identifica. N Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
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(Signature of otary Public-State of Florida (Signature of otary Public-State of Florida)
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.8/ 117