HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 1 19. Permit Number:
RECEIVED
• Building Permit Application JAN 0 9 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: A+ ew
Address: �+�®� r'c 3
Legal Description:
Property Tax ID hd-11�-1"1 ,V tr j' &164cc Lot No.
Site Plan Nam- ' Block No.
Project Name:' 1.2 z .4r s
Setbacks Front Back: :�?)-O 1 Right Side: eft Side:
DE ACE► I rEa$�; PT O OORK.
as -J r1 A 12
egae n�® 7/g e
NST �UCT;O; INF• ON•
Additional work to be performed under this permit—check`a t at app y:
_Mechanical _Gas Tank _Gas Piping - _Shutters _Windows/Doors
Electric _Plumbing
_Sprinklers -- _Generator _Roof
Total Sq. Ft of Construction: /z/ZY Sq. Ft.of First Floor:
Cost of Construction:$010 00P 0,0 Utilities: —Sewer —Septic Building Height:
Name oo c7/d e-1 Name:
Address: 5'0d / ' Company:
,City: C State:r6 Address:_
Zip Code:24- eA Fax: City: State:
Phone No. _5 d_ 49 Zip Code: Fax:
E-Mail::r4l(G 0A I.'le"ZM °• 62 M Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) St or County License
If value of construction is 2500 or more,a RECORDED Notice ofodommencement is required.
T NEW
IAL C«0 . N low OvoMMA O&
DESIGNER/EN INEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: 4'i ^Ad a'ZI&W1d2 ®-61' Name:
Address: Address:
City: 'S State: _X4 City: State:
Zip: YF3 19ei� Phone, £'-. 33 6 2- 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 obtain-financing,'consult'w'ith lender or'an attorney before
commencing work or recording our Notice'of Commencement.
Signature of Owner/Lesse ontractor as Agent for Ow ``` 'Signature of Contractor/License.Holder
STATE OF FLORIDAJ4 STATE OF FLORIDA
COUNTY OF ' Z� COUNTY OF
The fo_ oing inst ent was acknowledged before me �,_ T' a forgoing instrument was acknowledged before me
ms n
this day of 2012 by � q)� is day of ,20_ by
�E2
C�T
C Nv
(Name of person acknowledging) mJ
ame of person acknowledging)
(Signature of tary Public-State of Florid� ) (Signature of Notary Public-State of Florida )
Personally Known OR Produced Identification Personally Known OR Produced identification
Type of ldentific Type of Identification
Produced f'l7 n• r' I I C. Produced
,, A EY .HUMPHREY
Commission No. Commission No. (Seal)
:f. 3 MEXPI March F6 2019
r_
`'0'•••••'0. Bonded Thru'NotmPubhounderw(ders
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW' REVIEW REVIEW REVIEW REVIEW REVIEW-
DATERECEIVED 2o 11 ti 1►ftf, /-)
DATE 1
COMPLETED
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