HomeMy WebLinkAboutBuilding Permit Application Jan 26 2018 8:52AM HP Fax page 2
RECEIVED
ALL APPUCABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Perrr fitting Departme
n /-J ilie County
Date: Permit Number:
4(03 [
Building Permit Application
Planning a id Development Services
9uilding ai td Code Regulation Division
2300 Virgl ild Avenue,Fort Pierce FL 34982
Phone:(7 2}462.1553 Fax:(772)462-3.578 Commercial Residential
PERMIT PPLICATIaN FOR: To Select from dropbox, Click afTow at the end of fine
' !. `-� �'_ err ^
IN
Address: O r n
Legal Descr prion: 2 �d a 1 G d 3 �— 2.3
Property To ID#: .3WO ---5"a3 — 3� 8 — 00O — �� Lot Na.
Site Pian Nome: Block N .
Project Na e:
Setbacks Front. Back: Right Side: Leta Side:
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c1ditionalor to e e arms un er s permit—c ec all a app y:
WVA 11 Gas Tank Das Piping _Shutters F]Windows/Doors
Els c Q Plumbing Sprinklers 1i Generator C1 Roof Roof pitch
otal Sq.Ft f Construction: 13Q 5 Ft.of First Floor:
ost of Con truction:$ 3.rc7o. v Utilities: Septic Building Height:
101
I NO_ �!$`i r a .r' t�
ame dl PSS S° A 4Name: `S
ddress: 00 cx Company: ,v
ity: of ¢. State: ! Address: .�' s` er, r
Zip Code: Fax; City: r e- State
hone No. $-- S Zip Code: .34t j 9 Fax: 3 G 13
E-Mail: Phone No. -f,0— �2 1",6
11
in fee sir ple,Title Holder on next page(if different E-Mail: 671 r 6dry /'a d
orn the 0Y Fner listed above) State or County license: C Ac 1 A J sv
value of co Istruction is$2500 or more,a RECORDED Notice of Commencement is required.
Jan 26 2018 8:52AM HP Fax page 3
h°
D SIGNER/ NG NEER rotAicableMlifffflMul
ORTGAGE COMPANY: Not Applica le
N me. Name:
A dress: Address:
C ty: City: State: .
Ztp: Phone Zip. Phone:
F E SIMPLE ITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
N me: Name:
A dress: Address.,
Al
ty: City:
Z p: Phone' Zip: Phone:
O NER/COP TRACTOR AFFINIT:Application is hereby made to obtain a permit to do the work and installation as i dicated.
I c rtify that no r4ork or installation has commenced prior to the issuance of a permit.
St. ucle Countty� akes no representation that is granting a permit will authorize the permit holder to build the subject structure
whi h'is in.confli t with any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
str cture.Pleas consult with your Home Owners Association and review your deed for any restrictions which may apply.
Inc nsideration of the granting of this requested permit,I do hereby agree that I will, in all respects,perform the work
in a cordance w th the approved plans,the Florida Building Codes and St.Lucie County Amendments.
The following bt.ilding permit applications are exempt from undergoing a full concurrency review:room additions,
accessory struct ires,swimming pools,fences,walls,signs,screen rooms and accessory uses to another non-residential use
W1 RNING TC OWNER:Your failure to Record a Notice of Commencement may result In your paying twice for
imrovement to your property.A Notice of Commencement must be recorded and posted on the jobsite
be ore the fir t inspection. If you intend to obtain financing,consult with lender or an attorney before
co mencin ork or recording our Notice of Commencement.
.jze46 _at""'a--
Si nature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
ATE OF FLORIDA STATE OF FLORIDA
C LINTY OF S L v 'x e.. COUNTY OF v c. N e
T
eforgoing instrument was acknowledged before me The for ging instrument was acknowledged before me
th sday of a'g n nya r�X_20/if by this day off X a.Ln t-a rrAc ,20ZI by
1 f7 S b r I' e
Name of person making statement Name of person making statement
Personally Known X_OR Produced Identification Personally Known A_OR Produced Identification
T pe of Identlf cation Type of Identification
Produced Produced
`„Qy pv9,'' PATRICIA A. GARY�7N ,M1''e.ri� PATRICIA A.GARYQN
_•'r°. `�; tary PubllC• late of Florida .: ,�r°.. No Public-State of Florida
_ 13 2010
(Signature of S`tat�9 g0 R L FF 133580 (Signature of -SiORWi de OF 133580
"� Banded Thro rgh National Notary Assn. �� Bonded Through Natianal Notary Assn.
C mmisslon No. Commission N .
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
D TE
R CEIVED
D TE
C MPLETED
Rev.8/2/17