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HomeMy WebLinkAboutBuilding Permit Application Jan 23 18 02:45p First Choice Plumbing 7728797860 p.2
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTEDC
Date: 1 �-�J , 1 Permit N ber: - d J33
Building Permit Application
Planning and Development Services
Building and Code Regulation Division
2300 Orginia Avenue, Fort Pierce FL 34982
Phone: (772)462-1553 Fax:(772)462-IS78 Commercial Residential OL
PERMIT APPLICATION FOR: 'Y 1 \�X �j � v--_
PROPOSED_IMPROVEMENT LOCATION:
Address: L = _; +j
Legal Description: ,Q -c- ^�
Property Tax I D#: - CSS — -- Lot No.
Site Plan Name. Block No.
Project Name:
Setbacks Front Hack: Right Side: Left Side
DETAILED DESCRIPTION OF WORK:
JL
CONSTRUCTION INFORMATION:
Additional work to bertormed under tis permit-check all appy:
HVAC Gas TankGas Piping Shutters F]Windows/Doors
Electric © Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ 'FSC7 Utilities: Sewer ElS tic Building Height:
OWNERf LESSEE: CONTRACTOR:
NameC..a 4ze� Name: -tic.. ��.�.•r .c1
Address: La.1c_t_ �[i�aaec,. -'V- l $ Company: •3 ' k S. t� �c.crS
City: pos 4SA1 State: fit,, Address: Z
Zip Code:_3�-1QS.) Fax: City: State: V-
Phone No. Zip Code:-54 IckFax:
E-Mail: Phone No. -
Fill in fee simple Title Holder on next page(if different E-Mail:T r rwlo.i
from the Owner listed above) State or County Lice nse:
I
If value of construction is$2500 or more,a RECORDED Notice of Commencement is reqi dred.
Jan 23 18 02:45p First Choice Plumbing 7728797860 p.3
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Add ress:
City: State: City: State:
Zip: Phone Zip: hone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: P one:
OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit o 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 pert ilt holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or and co enants that may restrict or prohibit such
structure.Please consult with your Home Owners Association and review your deed for y restrictions which may apply.
In consideration of the granting of this requested permit,I do hereby agree that I will,in li respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St. Lucie County A rendments.
The following building permit applications are exempt from undergoing a full concurrent review: room additions,
accessory structures,swimming pools,fences,walls,signs,screen rooms and accessory u es to another non-residential use
WARNING TO OWNER:Your failure to Record a Notice of Commencement m y 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
commenci w r recording our Notice of Commencement.
Signature O ner/lessee/Contractor as Agent for Owner Signatur f ntra, Polder
STATE F FL IDA COU OF FL RIDT
COUNTY �I� L-��i-C/c� [�GL(ftC�
The forgo- instrum nt was acknowledged before me The for ��Ji}�g instru t was acknowledged fore me
this of � 201y by thi "'day of .7 20Y
Na a of persov/aking statement Name of per o aking statement
Personally nown 11�� OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Pylic-State o Signature of Nota ublic-S
�C J �
NANCY 'sE LANGF R� . D�7 P N EE LAVGFpRD
Commission No a1 co'rMiss�oxrcoz 7, mission No. M1n ssioxNGFOR
E-XPMEs:adobe,12,201.o r .oaoha iz zo2o
REVIEWS FRONT ZONING SUPERVISOR PLANS fVEGETAI ION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED I
Rev.8/2/17