HomeMy WebLinkAboutBuilding Permit Application Dec 15 2017 10:27AM HP Fax Page 2
LL APPLI BLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ` vs Permit Number:
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Building Permit Application
Planning an Development Services
Building an Code Regulation Division
2300 Virgins Avenue,Fort Pierce FL 34982
Phone:(77 )462-1553 Fax: (772)462-1578 Commercial Residential
ERMIT A PLICATION FOR: To Select from dropbox, click arrow at the end of line v
dress:
L gal Descrip ion: G r S C S- 3 � a
0+ 4 IV
P operty Tax D* 3 —J-01 -006-6-- 04 d "' Lot No.
Site Plan Na e: Block No.
P oject Nam $ S
Setbacks F nt Back: Right Side: Left Side:
0,Ar o lug 4 n, IQ, C S
N I: c o.n N� !� }0 N r 7e ere q+
S' ►40 1
S `F4SC) `f
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ONO,
i lonal w rk to brformed un er t is permit-chieckall apply:
HVAC Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
Electric a Plumbing Sprinklers I Generator 11 Roof Roof pitch
T al Sq. Ft of Construction: 5 Ft.of First Floor:
C st of Const ction:$ -7100 r Utilities: Sewer Septic Building Height:
N me c, M m e G Name: o e. ll ll s
A dress: Company: 4--f- Co N `o
C' : State: Address: S -5 5f V eI 00l fl
ZI Code: D Fax: /V A� City: r r e- State:-
al!
tate: /
Ph ne No. - 0 Zip Code: 3 9 JCA Fax: - 6G
E ail: Phone No. -
Fil in fee sim le Title Holder on next page(if different E-Mail: G re G C
from the Own r listed above) State or County License: SO /Sf
if v lue of cons uction is$2500 or more,a RECORDED Notice of Commencement is required.
Dec 15 2017 10:28AM HP Fax page 4 i
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ESIGNER NGINEER: _ Not Applicable MORTGAGE COMPANY: Not Appli le
arae' Name:
dd ress: Address:
ty State: City: State
P: Phone Zip: Phone:
E SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: Not Applic le
ame: Name:
ddress: Address:
ty: City
ip• Phone: Zip: Phone'
01 NER/ ff RACTOR AFFIDYIT:Application is hereby made to obtain a permit to do the work and installation as dicated.
I c ertify that In work or installation has commenced prior to the issuance of a permit.
Lucie Coun makes no representation that is granting a permit will authorize the permit holder to build the subject str r re
ich is in con ict with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohi it such
s Actture.Plea consult with your Home Owners Association and review your deed for any restrictions which may apply.
I onsideratll of the granting of this requested permit,I do hereby agree that I will,in all respects,perform the work
I iccordance ith the approved plans,the Florida Building Codes and St.Lucie County Amendments. ;
T following llding permit applications are exempt from undergoing a full concurrency review:room additions,
essory stru ures,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential us
ARNING OWNER:Your failure to Record a Notice of Commencement may result in your paying twice r
i proveme to your property.A Notice of Commencement must be recorded and posted on the jo ite
b fore the st inspection. if you intend to obtain financing, consult with lender or an attorney before i
c mmencin work or recording our Notice of Commencement.
I
gnature of ner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
ATE OF ORIDA _ STATE OF FLORIDA
OUNTY 0 "I I-V L ' e COUNTY OF S'a" c t
e forgoing strurnent was acknowledged before me The forgoing Instrument was acknowledged before me
is 15 da f p�ec�.ber' ,2017 by this JS! Qecc�lxr 1201 by
j r n . ' Lcr L ae
Na of person making statement Name of person making statement
ersonally K wn k OR Produced Identification Personally Known_j� OR Produced Identification
ype of Iden fication Type of identification
roduced Produced
,.:•.�°"b '�" I """ PATRICIA,",.GARYON
x y PATRICIA A.GARYON
p�, Notary Public State of FI ri
Signature o Notary Public-S t#b" " `t►ib�lmm.Expires Oct 13,2 1 nature of Notary Public 'f} omm. x es Oct 13,
%4, omm ss;c +a FF 1335 O
Commission M FF 13358 •;;; "
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mmission a. 3 "Cb""""' Et}6�alhrougtrNationalWary s . mission No. j 3
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MAN ROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REV
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