HomeMy WebLinkAboutBuilding Permit Application ALL APPLICA LE IN /MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I ( Permit Number:W&AM
RECEIVED
Building Permit Application JAN 16 2018
Planning and Development Services ITS W414 Alin MI'Mitting
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: Qf dro o IiF th end of line ` `e
PROPOSED IMPROVEMENT LOCATION: /
Address: r D Q L- 3 � 61—
Legal Description:
Property Tax ID#: 1�Jd l' 1�1_ d Otl 1 dna S Lot No.
Site Plan Name: AA 7 Block No.
Project Name: P 1 0 1 II W aP
7
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
'eeluotle /1�p¢m ( rJ pryC (- -yP� �l Jv� s' ►ny rs; i- Yom' Q0n�,`/
Pec k(e` t . ,TArf-( tII 1 l)f ltd Artllr f'(ndv"'(
CONSTRUCTION INFORMATION:
Additional work toe e orme under this permit-check a apply:
HVAC ff Gas Tank []Gas Piping In Shutters ❑Windows/Doors
❑Electric ❑ Plumbing Sprinklers E Generator Z Roof Roof pitch
Total Sq. Ft of Construction: ( L_ D S . Ft. of First Floor: 1(C) C)
Cost of Construction:$ ��, Utilities: Sewer[]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Name: AC AM ItC. 4 14 rfor(16br
Address: 3 �UQ r`1 D Q L Company: ,0
City: F4. �(elle State: P� Address: ifiVe 4 r
Zip Code:34-gJ_1 Fax: City: erwto- State:_E`-
Phone No. 706a-QQQ ` 13 Zip Code: 32+711 Fax: 777-- ?05--
E-Mail:
UJ-E-Mail: Phone No. 7 Z:?-- � ` 33
Fill in fee simple Title Holder on next page(if different E-Mail: h/P kt( C ((em � (, -b(('r
from the Owner listed above) State or County License: CCG #f-113 3 /3 0.5-
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 our Notice of Commencement.
Signature of Owner/Lessee/Contractor a gent Owner Signature�&Contkractor/U�icenseHol er
STATE OF FLORIDAI STATE OF FLORIDA I r
COUNTY OF i S COUNTY OF V'�)
The forg ing instru e_nt was acknowledge
fore me The f rg *ng instru ent was acknowledg fore me
this qday of �(G 20y thisday of a l�I � i �,20 by
Name of pers making statement Name of pers making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
/'), a� ��L _�_ - — ;'4���' _� i:Az
ignature of Notary`Pu iA Stak%gl&gg"R (Signature of Notary Public-State of Florida)
tl y Roberta Bennett
Commission No. c� NOATE O�FIL CDA Commission No. + NOTARY PURg�I)
oATE OF FLORIDA
2 Comm#FF952012 Wt'4�
Comm#FF952012
•INCE 1 �
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17