HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �,� - ) �, Permit Number: 17Iy
Ir il•
VED
Buildin g Permit Application O
Planning and Development Services DEC / 4 2017
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
M O E NITNEWANT1O N:
Address: '7VIa
Legal Description: non
Property Tax ID#: .3U I- T0.3-'00-?6- 0b Lot No.�U
Site Plan Name: Zo 32/lock No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
D DE�SC«' PTION OF WORK:
itAddi-in-nal work to e erformed under this permit-check all
1_1ri"Iap
y:
HVAC Gas Tank Gas Piping _Shutters Q Windows/Doors
11 Electric E] Plumbing Sprinklers 11 Generator E] Roof Roof pitch
Total Sq. Ft of Construction: SFt.of First Floor:
Cost of Construction:$ Q, �� uD Utilities: Sewer[]Septic Building Height:
® / ESS E C ON ACTOR:
Name Name:
Address: Company: �GLGe�v
City: State: Address: .Ci+r.�-
Zip Code: 34981 Fax: City:��^-mss ���,cei n �Statte:. a
Phone No. �/ - 3S%— 7,4103 Zip Code: ti'z �i Jy Fax: 7z,- U(�
E-Mail: 6�,wr)Y- 4-kr �/A A /,0&7,,A- Phone No. !77a -,f
Fill in fee simple Title Holder on next page( if different E-Mail:
from the Owner listed above) State or County License: GSC= OS30��L
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required:
PALCRNSTIC �� MIUMN
I 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:
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.
- - - - -- s
Slgnature`of Ow er/Lessee/Contractor as Agent for Owner Signature tf Contractor/License Holder
STATE OF FLORIDA _ STATE OF FLORIDA
COUNTY OF COUNTY OF
The fo�rgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this /(J day of 20 Eby this/a_day of 20 /7 by
WA�7,,
(Name of person ackno edging) (Name of person acknowledging)
(Sig tur f Nota Pubc-State of Florida) (Signa ure Natary_P/blic State of Florida)
Personally Known V/OR Produced Identification — Personally Known `" OR ProgAceJdPoUfication
Type of Identifica--- y. _ Type of Ide• J�
,uuY"Y,°
MOIRA L LATOS cti"' °��:
2 MY MISS 'Ff 144434
CONI ION
Commission No. =* :. MY COMMISSF f�144434 Com missio b. IBES:August 12,2 5�a1
f'IRES:A gus 12,2018 1'• F Bonded Thru Notary'Public Unde�+rtecs
of I q;•' Bonded Thru Notary Public Underwriters t�Afue4'°
Revised 07/15/2014
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DATE
COMPLETE
INITIALS