HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO UST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 2 Z0 z Permit Number:
R E C
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Building Permit Application DEC 2 8 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
PERMIT APPLICATION FOR:
PRPQSED INhR{}UIVIEiVT LOCATIO.N,. _..
Address: �/�
Legal Description:
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
,DE DESCRIPTON , wok
CONSTRUCTION 1NFOR(VI�iT10N
Additionalwor K tobe pertormed under this permit-check all that appy:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
Electric Plumbing, _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction: $ Utilities: —Sewer _Septic Building Height:
OWtER% .ESSET1R `
N
Name 1 me,
Address
City:_/ e �I�P.GGI° / State: Address: r y✓�D
Zip Code: 2 Fax: City: ra,2- ff L_b- State:
Phone No. Zip Code: 3 3/2 Fax:
E-Mail: Phone No 4� 3Z� 3� 1�
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License 2 7 `d(D
E Dd
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required. /�
suPP�,EM f�1TA ' NST U11100rN � Ar�'o x g
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.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA ll STATE OF FLORIDA
COUNTY OF S r Cr COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instru�M?ent was acknowledged before me
this Q-'7 day.of I'`e1 b"ket 20'q by this V7 day of /"r1fu ar J 203 by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature of NotaryPublic-State'of Florida)
Personally Known IL�roduce*JrRFg&W6.5pq Personally Known " ce ® L%.".O" IZ
Type of Identificatio ` NgttryP4110-Stativ Florf4e Type of Identification s �' �c., Notary -state of Florida
Produced .' . ii' C mlylon#FF 024649 Produced _' • ._ mission 0 FF 024649
My Comm.Erna Oct-5.,20% My Comm.Expires Oct-.5„2019
Commission No. "�'y' W.
Commission No. NaUondNotarYsn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014
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