HomeMy WebLinkAboutBuilding Permit Application ' I I
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTEDI
Date: Permit Number: i Nb'()l"t lD
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Building Permit Application i E
Planning and Development Services
Building and Code Regulation Division
!2300 Virginia Avenue,Fort Pierce FL 34982 i;
Phone: (772)462-1553 Fax:(772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the en'd of line
'PROPOSED IMPROVEMENT LOCATION
Address: acoca Cc j �'n C Jz�nc5cO fir
Legal Description: ' o r
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Property Tax ID#: Z442-9- g:",(:DZ-CK:)ICX�0-4 I , Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks . Front Back: Right Side: Left Side: I
DETAILED DESCRIPTION OF WORK,
CONSTRUCTION,INFORMATION
lAdditional work toe performed under this permit-c ec a appy:
HVAC 0 Gas Tank 0Gas Piping _Shutters I Windows/Doors
,114�_Electric 0 Plumbing O Sprinklers ElGenerator I k,Roof Roof pitch
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,Total Sq.Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ Utilities: _Sewer El Septic Building Height:
OWNER/LESSEE:` CONTRACTOR'!';.. 1
Mai,
Name aP.J&_,,4 �,1 Name: >11,
Address:_ l o _AAwUJcl- f):— - -_ Company: —1
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City: e-` . State: TL Address: lyA C:Z16�
Zip Code: Fax: city:
Stater
Phone No. ?0 ?l6 —l�✓�CI Zip Code: '; Fax: 72 577-�3f(6
E-Mail: Phone No. -7
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 riquired.'
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PPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:' Iia
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: { Not Applicable
Name' Name:
Address: Address:
City: State: City: I t State:
Zip: Phone Zip: Phone: I'
FEE SIMPLE TITLE HOLDER: Not Applicable BONDING COMPANY: i Not Applicable
Name' Name: M
Address: Address:
City: City:
Zip: Phone: Zip: Phone: 1
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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.
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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 1 will,in all respects,perform the work
in accordance with the approved plans,the Florida Building Codes and St.Lucie
County A mend=, ;
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 resultin 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. �(
Signature of Owner/Lessee/Contractor as Agent for Owner Signat of Contra r/License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF. COUNTY OF
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The Rrgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this!I—day of_Vrkc)„r 1.. 20 42 by this rl day of `!1r.., 20_U by
ii 016
N me of person making statement Na of person making statement
Personally Known OR Produced Identification Personally Kn n I OR Produced Identification
Type of identification Type of Identification !
Produ d C4t� Produced a, I ,
NgfdtureNof Notary Public-Sta f Florida) ( ' ature of Notary" PubIiicc4..%te_of_Flor1da=-
j, !' L'4sHAHNaINGRAM
Commission No. �, pL,(Seal)NA INGRAM Commission No i ..E�:—�us�;%t wry Public � jlQt Florida
Notary Public-State of Florida d
*�* �° My Comm.Expires a 20,2018
► . My Comm.Expires Dec 20,2018 U' 0.
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,4c . 0,4 Commission#FF 177249
cr onal Notary Assn.
'rFOF F` Bonded through i�ational Notar Assn.
REVIEWS FR= NING v---,,SUPE PLANS VEGSEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW ; REVIEW REVIEW
DATE j I ,
RECEIVED
DATE
COMPLETED
Rev.$/2/17 ! i
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