HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 12-;0-1- Permit Number: ���� ' ��v�•
- Building Permit Application REC�P VEta,
Planning and Development Services DEC 21 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: Electrical
PROPQSED,!lUIPROVEMENT LOCATION
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Legal
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Address icn 0x S• OCt--PkA"6v-
Legal Description: 3EASEI� RlEpew
Property Tax ID#: "1 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
a.
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bISMALIE ; 'Y'0WEIL to SuAlIZOOK A, CAOUCT G09_'
1`KMF WA i Q� (LEPc.AcELEALT.
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CONSTRUCTION 1Nf.QRMATIO,N k
Additional work to be nertormed un er t is permit–c ec a appy:
HVAC Gas Tank Gas Piping _Shutters []Windows/Doors
Electric ❑ Plumbing Sprinklers —Generator D Roof Roof pitch
Total Sq. Ft of Construction: SFt. of First Floor:
Cost of Construction:$ a00.00 Utilities:cnSewer 0Septic Building Height:
:OWNER/LESS'EE CONTRACTOR K
Name Is- Name:
Address: taim S . i)&A#.A 1)Q A--7 emy-E.L.C�.TQIC, I
City: ��c.r•15E.11 bEAW State: Address:42so SSE.�ttvlllE.i2CE. ��.
Zip Code: S 348577 Fax: City: ST%&.f%Lc State:
Phone No. Zip Code:34951 Fax:48 •–1V
E-Mail: Phone No. 7"1a-,5 O9 •yq,2-,Q
Fill in fee simple Title Holder on next page(if different E-Mail:COM LEcxjL,GaCQ eoPzAST. OET
from the Owner listed above) State or County License: c000aa�!s i
if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPtEME.NTAL:GONSTRUCTION LIEN LAIN INFORMATION`
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 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.
gna Owne essee/Contractor as Agent f r' ;,% i46dfre�&FCo_;?ra �ieTHolder
co
STATE OF FLORIDA MM STATE OF FLORIDA
COUNTY OF No COUNTY OFAQT(�
in-
The forgping instr ent was acknowledge) for gEiimw= The forgoing instrument was acknowledged before me
thiscP/ day of 20 by T this day of��E*� Mf ,20 by
Name of person making statement `oN Name of paking statement
Personally Known OR Produced Identific ion ersonall Known erson OR Produced Identification
Type of Identficati /r Type of Identification
Produced G{ JU Produced
(Signature of NotVy Public-State of Florida) (Signature of Notary Public-Stat 27 of FI�IrIufly0 LIONWiwd es e(�orl
OZOZ'LZ lljdv S3NIdX3
Commission No. (Seal) Commission NoFF`1Sf71057 90 I•L96d4i44)6SIWWO3 J&W
-_Lsnu AiR1QVl 711b4NRIN
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17