HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TOBE ACCEPTED
Date: l �� ® � Permit Number: 05���
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RECEOVED
Building Permit Application FEB 27 2017
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: IV P,t,_1 RGD/
PRaP®SED INnPROUE EENT LOCATION:
Address: J //-,,,
Legal Description:
Property Tax ID#: /y �3 d23 �� '�f Lot No.
Site Plan Name: Block No.
Project Name: 1 1/e4- ?&—x
Setbacks Front Back: Right Side: Left Side:
DET ILED D'E�SC =IPTION OF WO�R�K:
-,0V
CONSTRaUCT10 IN�F®.RM�ATIO .:
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 A� Pitch
Total Sq. Ft of Construction: .33 U� Sq. Ft.of First Floor:
Cost of Construction: $ ly-4.1-D® Utilities: —Sewer _Septic Building Height:
OW
LE ESS CONTRACTOR:
Name J_kt-lir C v/1 Name:
Address: a/.� Alamo wd' J>R Company:
City: -PS/_ State: Address:
Zip Code: -4-A Fax: City: State:
Phone No. 72,9- ` 36/--3-7 S -2 Zip Code: Fax:
E-Mail: ) Ca/0/✓4!�3,..11,474 1,r Phone No
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 required.
SUPPLEMENTAL CONSI'R CT10N LIEN LAW IiNFOR�MATI®N:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: 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 or
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. If you intend to obtain financing, consult with lender or an attorney before
commen ' w or recording our Notice of Commencement.
Sig t e er/Lessee Contractor as Agent Signature of Contractor/License Holder
STATE OF FLORID > ���� STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instrum t was acknowledged befor MCK The forgoing instrument was acknowledged before me
thisZ7day of 20/7 by m this day of ,20_ by
z�
C QTS
JG _
,A
(Name of person acknowledging) P N I (Name of person acknowledging)
(Signature of IN o ary Public- tate of Florida (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of IdentificationA/ Type of Identification
Produced 9 , 'C; Produced
Commission No. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED 1
DATE
COMPLETED j
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