HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED i
Date: Permit Number:
F
Building Per it Application �uN °18
Planning and Development Services Per St. _%9c%e��ountY„t
Building and Code Regulation Division
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2300 Virginia;Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential c
PERMIT APPLICATION FOR:
I
PRC?PtJSED {NPROVEMENT LOCAT{0►N;
Address:
6' 7 yr N
Legal Description:
Property Tax ID#: `'1 �' ��' Lot No.
Site Plan Name: /A/ ,/" • Block No.
Project Name: 174 ®- / ,
Setbacks Front Back: Right Side: Left Side:
DETA{LED IPT{DN CSF WORK;
��c� ai'�Y�,� C ��e �, Ua► ear �'� �1cQ ,.S' ���
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C�NSTR+UCT{. INFQRMATION:
Additional work to be pertormed, under t is permit-c ec a t at a p y:
I _Mechanical _Gas Tank _Gas Piping Shutters _Windows/Doors
_l4lectric _Plumbing _Sprinklers Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of irst Floor:
Cost of Construction:$ Utilities: —Sewer _Septic Building Height:
0ONVIRMLE=�S�SE CONT �R:
Name,. . Name: Gi (e,l' �- 4? -,1
Address:
;.<.:. Company: Feer-P--7
City: . State:_ :;P,ddtess O- y�Q?C
;Zip Code: Fax: CState:
Phone No. d Fax: ?7�
E-Mail: Phone No_ 7 2
Fill in fee simple Title Holder on next page(if different E-Mail d`.S'Q.?-I-e-IC )c dL
from the Owner listed above) State or ICounty License �7( "
If,value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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SU=1 I �ENl E tib �1 COR1
DESIGNER ENGINEER:- _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: State: City: State:
Zip: Phone Zip: Phone:
FEE SIMPLETITLE 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 tke,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 you intend to obtain financing, consult ith lender or an attorney before
commencirjg work or rec rding your Notice of cerr
Si re of Owner/Lessee/Contractor as Agent for Owner nature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF &
The forgoing Inst ment was acknowledge before me The forgoing instrument was acknowledge before me
this day of A jAAP 20J4 by this Q5day of 20� by
. � A
Name of person making statement. \ Name of person aking statement.
Personally Known OR Produced Identification V Personally Known OR Produced Identification
Type of Identification Type of Identification
Pro uced Produced
cry
igna ure of Notary Public-Stkle of Florida) (Signature of Nota
,4Atyp�11 KAREN S. NIELSEN
Commission No. (Seal) ,y. .x-. . mmission No. ;2° ��,state of Flor ;[�gtary Public
v LASH INGRAM =* - mmissio �t 207484
Sate of Flori a My Cornmission Expires
• My Co m.Expires Dec 20, 01 Bit
REVIEWS FRONT =N,9 G po @ERVIfSM4 LANS VEGETATION SEA TURTLE MANGROVE
COUNTEV�ond�d ro IEW REVIEW REVIEW REVIEW
DATE -
RECEIVED
DATE
COMPLETED
ev. 8/2/17