HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED /
Date: a���� ) Permit Number: do. 0 l q 77
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Building Permit Application FEB 2 9 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:
PRQPOSED IN. ROUEMEIT LQCATIC3IV .
Address: op(-/) ( �� �✓1 y�o�
Legal Description: 5-se- � „%ar,�ai ,3 mac✓ �, k�S�" lam`'
PropertyTax ID#: a� O� t !o lP r�005 OPD - Lot No. J�
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
40 cc
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CQNSTRl1CTI0N tNFORl1%IATIQV k
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Additionalwork to be pertormed under this permit-check allt at appy.
_Mechanical _Gas Tank _Gas Piping Shutters _Windows/Doors
ctric —Plumbing —Sprinklers ;Generator —Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ �J �Ga Utilities: —Sewer _Septic Building Height:
OWNERjLESSEE. y h \r
CaNTRACTOR
Name c2 a Name:Q
Address: u-� Company.
City: , State/L Add pre �2�, .Zip Code: !? Fax: City /�f�yci� State:/ILPhone No. '� - �� C Zip 66r? Fax:
E-Mail: Phone No. �d
Fill in fee simple Title Holder on next page(if different E-Mail eg,&&04_f:4Lym� e/�
from the Owner listed above State or CountyLicense
L!
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 in pection. If you intend to obtain financing, consult with lender or an attorney before
comm Ing vydry or recording our Notice of Commencemen
a re of Ow /Lessee/ ontractor as Agent r- Sin ure of C ractor/License Holder r=
STATE OF FLORID STATE OF FLORIDA
COUNTY OF m COUNTY OF
am1a zM�
The forgoing instru nt was acknowledgjd efor DO 9 The ing instrument was acknowledged befo fngse m
this day of 20/ by 993 thiday of 20� by
RE-
co
c
(Name of per on acknowledging) a;N (Name of person acknowledging)
a
(Signature of Notary blic-State of Florida ) (Signature of Notary blic-State of Florida)
Personally Kn OR Produced Identification Personally Know OR Produced Identification
Type of Identificati ' 1 nn'' Type of Identificatid
Produced �1 Produced-
Commission
-
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
ev. 712014