HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED )
Date: �• �• �' Permit Number: / i O�) — v3 57
Building Permit Application FEB 14 2018
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: RCVAAP--S
C1tSED-I--
Address:
Address: a ?Pt3�fltEillT
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Legal Description:
Property Tax ID#: 134116/2 — &Z-5-e/ Doo _ t Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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Additionalwork to be pertormed under this permit--check all that appy:
_Mechanical _Gas Tank _Gas Piping --Shutters _Windows/Doors
✓'Electric _"Pluffmbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor:
Cost of Construction:$ <_ . gam ' Utilities: _Sewer _Septic Building Height:
{ ERLEE ' CONTRACTC}R. °
\ .
Name mss Name:
Address:_ —7119 eee-—S' C� � �r� Company:
City: ,% State: Address:
Zip Code: y 5S/ Fax: City: State:
Phone No. 77- - 35"3 — 233 Zip Code: Fax:
E-Mail: -1'-lzPL� n, Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
I
SUP
PEMENT L GIJCTI9N L{EN t.AW INFORMATIClt. h
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: ---Name:
Address: Address:
City: Stater 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. I u intend to obtain financing, consult with lender or an attorney before
commencing work or rec_ofding your Notice of Commencement.
Signature of Owne /Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDSTATE OF FLORIDA
COUNTY OF ��' COUNTY OF
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The forgoing nstrume t was acknowledged bLLea
g gig The forgoing instrument was acknowledged before me
this day of 20� y o this day of .20_ by
co can
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�Vn v
G s e� w
(Name of person acknowledging c (Name of person acknowledging)
' t,
of No Public-S F (Signature of Nota Public-State of Florida
(Signature y c tate of lorida) ( g Notary )
Personally OR Produced Identification Personally Known OR Produced Identification
Type of Iden ificati Type of Identification
Produced AC 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
R-e—v.7/2014