HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED II G 2
Date: Permit Number: i D ✓ r �� -
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RECEIVE
IIIIIIIIIIIIIIPP Building Permit Applicati n MAR 2 6 2018
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982 Permitting [�@paI"tl1'le
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Resi enft Lu i County, FL
PERMIT APPLICATION FOR:
P`RO.P®SED LNPR41lEMENT LOCATl ff}'N:
Address: / - IA l
Legal Description:
Property Tax ID#: /361 &06 _1 '4 (:) :7 —M 0 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks, Front Back: Right Side: Left,Side:
DETAILED DEQ-CRIPTION
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(QMQSl2J` JJL:)0_fA X C
C�O'NySTRUCTIa' 1N1=0RMATION:
Additional work to be pertormed under this permit-check all that appy:
_Mechanical _Gas Tank —Gas Piping —Shutters Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq, Ft of Construction: qvri-u'v k,/- Sq. Ft.of First Floor:-. ..
Cost of Construction: $ 0 6 Utilities: _Sewer _Septic Building Height:
0W ER/LE=�SSEE; CONTRACTOR:
Name C / Na'me`.
Address: te.IQ 664 Lid Company:
City: State: PL Address::,
Zip Code: O Fax: City. State:
Phone No.77-7�( 94 J Ziptode: 'i Fax:
E-Mail: Phi0 e-- or,
Fill in fee simple Title Holder on next.page(if ifferent 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.
SkIPPLEMENTAL CONSTR�UC�TION Lf�EN LAW 1NF®R+NATION:
DESIGNER/ENGINEER: _ Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
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 our property. A Notice of Commencement must be recorded and posted on the jobsite
before the fi stinspe ion. If you intend to obtain financing, consult with lender or an attorney before
comrfien6ft work ortgcorcling your Noft of Commencement.
ign ture Ow e0/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FL RIDA STATE OF FLORIDA
COUNTY O S4 LU(S a COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this'Z( day of M A.R.G. , 204 by this day of 20_ by
Roc, r> be,�e,tid
(Name of person acknowledging) (Name of person acknowledging)
(S nature of Notary Public-S exrof Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced �a Produced
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Commission No. (Seal .,;;���;;�' Commission No. (Seal)
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REVIEWS FRONT ZONING R PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW / REVIEW REVIEW REVIEW REVIEW
DATE 0onZW
RECEIVED ' 02
DATE " W<O
COMPLETED P'm N C
Rev. 7 —
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