HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: l0 �- Permit Number: /l S0,2 U e2tP.
Building Permit Application FEB 2 6 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: To Select from dropbox, click arrow at the end of lineQ6 CIF . 1W
PROPOSED_IMPROVEMENT LOCATION: ,
Address: z3�C A4Y&/re,IA— 0 �
Legal Description: /eA i! /T
Property Tax ID#: .?Y19• _573,e> + D a:5:3— d 0 d—/ Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
CONSTRUCTION INFORMATION: -
Additional work toa nertormed under this permit—check a appy:
HVAC Gas Tank Gas Piping _Shutters Windows/Doors
Electric 0 Plumbing ❑Sprinklers ❑Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: Sci. Ft.of First Floor:
od
Cost of Construction:$ l9Utilities: Sewer[]Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name-,£Gell /L.SS'c�l Name: AWq ! '
Address: el-Al 0V9k egg Company: LVLo
City: State)!! Address,
Zip Code: Fax: City: MY State: r
Phone No. ? i, — �'� �9�f/n Zip Code: Fax:
E-Mail: Phone No. G—
Fill in fee simple Title Holder on next page(if different E-Mail: ILA
from the Owner listed above) State or County License: C&1- 004A
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LTE:N-LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: X 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.
Sig atu Owner/Lessee/Contractor as Agent fo Sig a ur of Contractor/License Holder
`rf_5.:� 1 SIF.• •��-
STATE OF FLORID
STATE OF FLORI
COUNTY OF COUNTY OF W
o, �X�a
The for oing instrumen was acknowledged befor. i The forg ing instrum nt was acknowledgedbefor r ��
this day of 20� by 2 F,�s this day of 20 y
49
Name of person making statement ��im Name o per making statement a N�
Personally Known ✓ OR Produced Identifica q1 Personally Known OR Produced Identific
Type of Identification iN Type of Identification y N
Produced Produced
,.
Lr
(Signature of N t ry Public-State of Florida) (Signature of Otary Public-State of Florida)
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17