HomeMy WebLinkAboutBuilding permit application �o
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ,z 3 Permit Number:
R E C'-= 2 FSO 0 9 2017
Building Permit Application
I 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: To Select from dropbox, click arrow at the end of line
SPR®`ROBED IMPR®UEMENT LOCATION. , . \
Address: 913
//��
Legal Description: 11106 -7
Property Tax ID#: Lot No.
Site Plan Name:'
Q Block No.
Project Name: �`�
Setbacks Front IV Q Back: Right Side: �''�9 LeftSide:
DETAILED DESCR{IPTION ®F 1NORK:
a,�
CONSTRUCTION IN'FOR�MATION:
Additional work toe e orme under this permit-check a appy:
HVAC 13 Gas Tank ❑Gas Piping Q_Shutters Windows/Doors
Electric 0 Plumbing Sprinklers E]Generator FIRoof
Total Sq.Ft of Construction: gg S .Ft.of First Floor:
Cost of Construction:$ �,9, Utilities.. Septic Building Height:
OWNERjLESSEE: CQNTRAOR:
Name XZ& a220& 12 62 ALV Name: l�1!fes" -5 n i
Address: 'POO lav ®a Company. ASQ�Cril D6/
City: 1�,/� y ,LGA State: Address' SCB 5 B c
Zip Codek-,5a� Fax: City: I State
Phone No. Zip Code:: 8 I Fax: 51 1Jag 5 ��-
E-Mail: Phone No. %1-'7 :!-(,)��9
Fill in fee simple Title Holder on next page(if different E-Mail (i i @ SO lDE&.J&,I S lY�r ,6W
from the Owner listed above) State or County License: k l 4 1 AS
1
If value of construction is$2500 or more,a RECORDED Notice of Commencement Is required.
aqa� �
s'
4
I
SUPPLEMENTAL CONST UCTION LIEN LAW FNFC�RIUTATION:
DESIGNER/ENGINEER: J _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name: .4 /&
Address: Address:
City: State: City: State:
Zip: Phon Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone:_ Zip: Phone:
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'obsite
before the first inspection. If you intend to obtain financing, P J
p nancin consult with lender or an attorney f
Y g, ey be ore
copmencing work or reszifelipamur Notice of Commencement.
r
S
_Sig of Owner/Lesseege
/Ant Sign re of Contractor/License Holder
STATE OF FLORID STATE OF FLORIDA
COUNTY OF �� �� COUNTY OF C'6 ¢I
The for oing ins t was acknowledged b fore me The forgoing instr e t was acknowledged before me
this,day 20this day of i LIL • 20 17 by
Name of person acknowl in
( p g) (Na of pets n acknow ed '
FF
—ISIgnature o ota ubli tate of Florida) (Si at a of1Vw
otary Pub c-S ate of lorida
Personally Kno OR Produced Identification Personally Knn OR Produced Identification
Type of Identifica ' Type of Identifi ting Fhoduced _ A
�QtiY°K ., ,,,,,,, CHARNN�_epHNSON
Commission No. '' - r MY Comm] Q�I, FF014070 Commission No. °o`"aNLA
�P6a�;-- tar PuLII r�
;�., ,; EXPIRE 27,2017 - _ y t to of Florida
....?�° Bonded Thru Notary Public Unde carters J FF
Commission# 930970
OF FILO plres c ,2019
"�����"` `Bondedthrou
Revised 07/15/2014 through National Notary Assn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW RE EW REV W REVIEW REVIEW REVIEW
DATE
COMPLETE ( ��
i
INITIALS
I