HomeMy WebLinkAboutBuilding permit application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
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Date: Permit Number:
, .. a R E C E I V rD JAN 17 2017
Building Permit Application
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 i Residential ✓
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PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line {Za
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Property Tax ID#: d3a3-.33 a-003-Ooo- s ! Lot No.
Site Plan Name: Block No.
Project Name:
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Setbacks Front Back: Right Side: Left'Side:
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,tee.... "Pr. aZ - u` .` -.:t'h-nr','.s.;."d4�„c Additional work to enerformed under this permit—check a apply:
❑HVAC Gas Tank Gas Piping Shutters a Windows/Doors
Electric Plumbing HSprinklers Generator J2 Roof Roof pitch
Total Sq. Ft of Construction: 5-00 S . Ft.of First Floor: �
Cost of Construction:$ Utilities: SewerE]Septic Building Height: I a'
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Name M,c,t,e,g_( Q 0&-�C.d Name: �c,�do )r.✓�-
Address: _040 (nvi&Si9,nr_ lQlvv Ayzo( Company:
City: '�TY4 ,ricer _
Qi State: Y1- Address: ?l(�s(.: (,,., C. -'9L'L
Zip Code: d 1 QS Fax: City: Stater
Phone No. '1)6fa` Zip Code: 3dk l4- Fax: 9 37_— 2 02
E-Mail: Phone No. 2�
Fill in fee simple Title Holder on next page(if different E-Mail: ej.k ezUY-VS &—;' czc-)t. C-,o -�
from the Owner listed above) State or County License: c_r c i??cry 4-
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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-SUPPLfM�NTAL C�NSTRUCT>ION LfEN LAW INFORMATION T � � _� j.
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not Applicable 'y
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:
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 obtain financing,consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
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tgnature of Ow r essee/Contractor as Agent for Owner Signature of-Cont e o der
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF YW-,,,AY) COUNTY OF ;/haw,+12
The forgoing instrum nt was acknowledged before me The forgoing instrument was acknowledged before me
this !,/� day of 0 20 L+by this 19, day of r CA V) 20 a by
(Name of person owledging) (Name of pers9p acknowledging)
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identificatiorti Produced Type of Identificatior Produced
Commission No. Se I mmiss4�
.tipgr;'ny'., THERESA DE RITA THERESA DE RITA
's.. InWAA1001MIa PF 0699291 11 bIY COh0MISSIMI#FF 062929
`} EXPIRES:October 29,2017 !- fir = cta er 29,2a1
Revised 07/15/2014 , 'Y Bonded Thru Notary Public Undarv+ritari i,q t4Z` BondedTlim\btaryPub!icUndenvrder,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS
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