HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATIOI1CTO BE ACCEPTED
Date:
• ] �� Permit Number: 17 03,0 0 0
M ilNa'oY+Y��. YI�
RECD1 `.
Building Permit Application' MAR /1 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 1'
PERMIT APPLICATION FOR: er�C•
PROPOSED IN!h .Ol/EMENT LOCATION.
Address: f l0 S UVIi�rDS ��(
Legal Description:
Property Tax ID#: - - -COOS -O A D - 3 Lot No.
Site Plan Name: COUL n 'I Block No:
U
Project Name: CO L COth g e�N
Setbacks Front Back: Right Side: `Left Side:
DETAILED DE�SCR=I�PTION OF WORK:
rigs r 3ST 6 6-Yo0` _�.Rtit[a, Yq,eMAJW3 int/ C4CX!��Y��t�f Q Y 14,90 A'1 /'u QA! -0 P-9
3g�� �� -F Wadi� ce•
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=@%N-STRUCTfON INFORMATION;
Additional work to be pertormed under this permit-c ec .a tat appy:
_Mechanical _Gas Tank _Gas PipingSliutters _Windows/Doors`
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor.: ;
Cost of Construction:$ 1666 Utilities: —Sewer _Septic Building Height:
OWNER/LE=�SSEE. CONS RAs OR:
Name M/P(Pj4 Name: _-
Address: 1 1)0 " �14 ICf-Vl NQS PPJ L Company:
City: T pl h elrzck_' State:_ Address:
Zip Code: J� Fax: City: State:
Phone No. Z 2 Z�- �� Zip Code: Fax:
E-Mail: M000 fOCC�t��/A LQ . 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.
K
010060MARME � (a103NS�T n �TIGN 000, RMA►
"ME
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 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. If you intend to o Ging, consult with lender or an attorney before
commencing work or recording our Notice �rrr ncement.
O T
Signature of Owner/Lessee/Contractor as Agent for 4Q Signature of Contractor/License Holder
0
a ms m
STATE OF FLORID4—
�� STATE OF FLORIDA
COUNTY OF w o= COUNTY OF
C pT 2
The forgoing instrument was acknowledged before a o�m The forgoing instrument was acknowledged before me
this f day of 20 .by . �N` this day of 20_ by
(Name of person acknowledging) (Name of person acknowledging)
9JJ'b_JJ14_ E-&2aad�
(Signature of Ptary Public-State of FI ida) (Signature of Notary Public-State of Florida )
Personally Known OR Produced Identification .l� Personally Known OR Produced Identification
Type of Ids ' is ion , Type of Identification
Produced L• Produced
Commissi o. (Seal) Commission No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014