HomeMy WebLinkAboutBuilding permit app All APPLICABLE INFO MUST BE COM FETED FOR APPLICATION TO BE ACCEPTED
99
Date: Permit Number: �l ' MZQc�,'
RE�r6,b �.. r77
-
EC
Building p p Permit A licati tq •p
_JAN ..3,a 2017
Planningand Development Services P,_, ,1
P
Building and Code Regulation Division St.
2300 Virginia Avenue,Fort Pierce FL 34982 St.L cie County, F1_
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residentba`� {i -
PERMIT APPLICATION FOR:
PR®PQSED NR'ROVEMENT LOCATI®N:
Address: 31C9 \ >V h _ U Z. f
Legal Description:
Property Tax ID#: Ca 03. 0 I(00 - ®V M Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DE AIL D DE�SCR RT 0' 4 WOR
rf MOM op 44�_p o k -6 e
CONST WON 0 N IWROI
Adclitional work to be pertormecl uncler this permit-c ec -all that apply:
_Mechanical —Gas Tank —Gas Piping —Shutters Windows/Doors
—Electric —Plumbing —Sprinklers —Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ AC�•C70 Utilities: Sewer Septic Building Height:
OWNER/L�S�SEE: CONTRACTOR:
Name _ ellI Name:
I
Address:-JVbi!�n—leir( Company: 'I
City: �� •-?i efCc_ Stater Address:
Zip Code: Z Fax: City: State:
Phone No. :�-6 Z 21t4— i Zip Code: Fax:
E-Mail:5V1QdtgJeJC_I�I V QrYIAI I - wrn . 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.
P s' S R T • N IE ORMA 10
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 obtain financing, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee Co actor s A ent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instr ent was acknowledged before me The forgoing instrument was/acknowlecig ;fore me
this 31 "day of 20 n by this day of _ by
(Name of person acknowledging (Name of person acknowl Bing)
(Signature of Notary Public-State of Florida) (Signature of N ary Public-State of Florida)
Personally Known OR Produced Identificati� Personally nown OR Produced Identification
Type of Identification Type of I entification
Produced Produc d
Commission No. (Seal) Commission No. (Seal)
-LASH HNAINGRAM
REVIEWS N4NEV Publ csmeRWO PLANS VEGETATION SEA TURTLE MANGROVE
COU _ fyMmm. pirgf�� 2018 , REVIEW REVIEW REVIEW REVIEW
DATE °` 1
"'F o�, y %1 ( 1 RECEIVED hr u h Nati al Notar Assn.
DATE h i
COMPLETED
ev. S1Mltnvcv�L
0�JmA