HomeMy WebLinkAboutBuilding Permit Application Mar 20 2018 8:43AM HP Fax page 2
LL APPLIC BLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Q'� Permit Number:
Building Permit Application
nn ng an Development Services MAR 2 p 2018 I
wilding and Code Regulation Division i
300 Virgini Avenue, Fort Pierce FL 34982 S . LuSie County, Pe itting
hone:(77 )462-1553 Fax:(772)462-1578 Commercial Re
ERMIT A PLICATION FOR: To Select from dropbox, click arrow at the end of line J
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A dress: l� �17 IV
L al Descrip ion: U {{ dr C s o a-5
Lot a Md ,$)I o /2ti xj Ia. B _ 30
Pr perty Tax I #:_` -3k ~-6'0 a ^ d Oo,S--000 -$r Lot No, f�S�
Si Plan Nam Block No.
Pr jest Name:
S tbacks Fr nt Back: Right Side: Left Side:
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itiona wo to a rformcd un er t is permit-c ec T" _� pp y:HVAC Gas Tank Gas Piping hutters Windows/Doors'
Electric Plumbing Sprinklers Generator Roof Roof pitch
Tot I Sq. Ft of onstruction: to 2�4, S . Ft.of First Floor:
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Co of Construction: $ aS00, " Utilities: Sewer Septic Building Height:
64 7F'
Na e 0 M e Y'7 nt N`` Name a b 0r' wrt11�S
Ad ress: 03 c,h Company: O i (_o rd rd l
Cit r G(a� State: Address:_S- M- f, U c r 2r
Zip Code: Fax: i✓A City: Stater
Ph a No. -^'sZ 2363 Zip Code: 3 Fax:Pj').2- 94'4 /3
E- ail: N Phone No. 07^ 470--
Fill
70 -Fill in fee simpl Title Holder on next page(if different E-Mail: G G o N t0 G Q Ye, �ao , e e w,
fro the Owne listed above) State or County License:}
If va ue of constr ction Is$2500 or more,a RECORDED Notice of Commencement is required.
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Mar 20 2018 8:43AM HP Fax page 3
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ESIGNEENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
ame:_ Name:
ddress: Address:
itT. State: City: State:
ip: Phone Zip: Phone:
JqEE SIMPL TITLE HOLDER: Not Applicable BONDING COMPANY: —Not Applicable
a rn'le: Name:
dd ress: Address:
ity: City:
ip: Phone: Zip: Phone:
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t�4TRACTOR AFFIDVFT:Application is hereby made to obtain permit to do the work and installation as indicated.
I work or installation has commenced prior to the issuance of a permit.
St Lucie Cou ma ke
ct w%no representation that is granting a permit will authorize the permit holder to build the subject structure
h is In any applicable Home Owners Association rules,bylaws or and covenants that may restrict or prohibit such
st cture.Plea consult with your Home Owners Association and review your deed for any restrictions which may apply.
In lonsideratio of the granting of this requested permit,I do hereby agree that I will,in all respects,perform the work
in cordance th the approved plans,the Florida Building Codes and St.Lucie County Amendments.
Th following b Wing permit applications are exempt from undergoing a full concurrency review:room additions,
a sory stru res,swimming pools,fences, walls,signs,screen rooms and accessory uses to another non-residential use
W NTNG 7 OWNER:Your failure to Record a Notice of Commencement may result inyour paying twice for
im)rovemen to your property.A Notice of Commencement must be recorded and posted on the jobsite
be'ore the fi inspection. If you intend to obtain financing,consult with lender or an attorney before
co nmencing ork or recording your Notice of Commencement.
,12
Si Inature of 0, iner/Lessee/contractor as Agent for Owner Signature of Contractor/ticense Holder
S
ATE OFF )RIDA STATE OF FLORID
C LINTY OF. S�- COUNTY OF ti.L_J e-
Tt e forgoing in ;trument was acknowledged before me The forgoing instrument was acknowledged before me
th s 11 4*day c Mxeeln 20_JL by this lit"day of M&rc.k — 20—C by
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PATRICIA A.GAR N DqSign re of Notary Public-State of Florida
Notary Public -slate o Florida
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co' mission Nc FF 13)S S'*Comm-Expires sion No. (ftd)CIA A. GARYON
Commission # FF 1 3580
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