HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO/MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTEDy�c•;�,�,i�-
Date: `1 • Permit Number: 1'701 �4493
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RECEWED
. Building Permit Application
Planning and Development Services DEC.1 9 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: . C
PRQPOSEDINiOUEMENT I
LOCATON s F
. � . ..
Address: Q-32q 66•kcur Cart' A, I-o elf
Legal Description:
PropertyTax ID#: Lot No.
Site Plan Name: #grivar Cove., Block No. a
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORKaz
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®:ni��geal C'/pc�YiCd el -i—e Weft/
CONSTRUCTION INFORMATION
�,._ .�_ INFOR _, .. _
AV
i' 1tiona 'wor to a per orme un er t is permit-check a It at appy:
_Mechanical -Gas Tank -Gas Piping Shutters _Windows/Doors
_,flectric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ �.® - e o Utilities: —Sewer —Septic Building Height:
avuNER/LEss: sCONTRACTOR x
w �t
Name , Name: .
Address: /0 au,- Company:,Q�/_Azyre zzPar;&--
City: y; //i State: Address: ill Grov��ul .S`��
Zip Code: Fax: City: �,,�, — State:
Phone No. q6 -7/9# Zip Code: -1:14 Zf 9 Fax:
E-Mail: Phone No 370-43E"749
Fill in fee simple Title Holder on next page(if different E-Mail �f/f'J►�wse;!-�J.i/4 door�.�i->
from the Owner listed above) State or County License G 000,222
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW 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.yodr Notice of Commencement.
Signat r' f ner/Less ontractor as Agent . Sign at re on actor/Licen Holder N
STATE OF FLORID E STATE OF FLORIDA !gym y
COUNTY OF COUNTY OFEa?
The forgoing instru ent was acknowledged befor m The forgoing instrument was acknowledged4efore o�Q R
this day of 1 C' 20L by this f q day of e r _ . ?20 by Q�X
79
k .Yo
me f erson cknowledging) (N a of person ag nowleclging)
AA,,, C�s
(Signature of No ry Pub' -State of Florida' (Signature of Notary ublic-State of Florida
Y
Personal) Known 7011 Produced Identification Personally Known_Z�OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/201.4