HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: t 1 Permit Number:
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RFCEI` 77D JAN 12 2917 �I-e�'R- '�-��� rAq
Building Permit rAipplicution
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: Pool inground
PROPOSED IMPRQUEMENT LOCATION ` ` _ " �'` j 1
Address: �3qOq 5 p�-
Legal Description:
Property Tax ID#: 44-3-fro 1. 000 • a Lot No.
Site Plan Name: 1 Block No.
Project Name:
Setbacks Front N ` Iq Back: �`� Right Side:.Left Side:
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itiona wor to+ e e orme un er t is permit-c ec a app y:
�HVAC �Gas Tank ❑Gas Piping _Shutters �Windows/Doors
i
Electric 0 Plumbing Sprinklers Generator ❑ Roof
Total Sq. Ft of Construction: n �f S Ft.of First Floor:
Cost of Construction:$ <"Jc7� O` �`T• Utilities:nSewer❑Septic Building Height:
-
Q1IVNER/LESSEE
,�GONTRACTOR. ,t
.,_cr... �--��.. *'._.--.-.�_"`a`_._Y.a; ..,:r.Y.'�.�ux. _t r.k.r•€a_.:-...' ...._.d,?, r, r.,c._suY..:2-.`v,.r.t"..�T.-••'.^.
Name Name:
Address: Company:
City: . ple'r-Ge- State:2R- Address:
Zip Code:3)l0 Fax: City: lz 1 f 1n?.1� State:,
Phone No. 71� '�1� '1�S a Zip Code: 34 'B P Fax:77,9•AI&7•l Iyg4
E-Mail: Phone No. 77�• g7$ - �75a
Fill in fee simple Title Holder on next page(if different E-Mail: Pher Q n 'r O ,O,(M
from the Owner listed above) State or County License:0—
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
DESIGN /ENG EER: Not Applicable MORTGAGE COMPANY: . :.:-Not Applicable
Name: Name:
Address:lo Address:
City:10 o_Vjea_Q State: 45L 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 AFF.IDVIT:.Application is hereby made to obtain_ a:permit to do-the work and installation as,indicated.
I cerfifyth'at 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 b
co'mmencin work or recording our Notice of Commencement.
Sigh ature ner/AgerItTLessee S' a ,01 f ntractorf Li nse Holder
STATE OF FLORIDA ATE OF FLORIDA
COUNTY OF . �!�,�' � COUNTY OF -ttLJ�-�
The forgoing�n ent was acknowledg 0 before me The forgoinginstr meat was.,ackn9wlg0ge before;me
:;
this day of 20;' by this A day:'of:'. 201: by...
Q�r 1 Lanou�
(Na"i of rson ackno ledging) Nam f person acknowl dging)
Signature of Notary Public-State of Flon 6ignature of Notary Public State of Florida, -
Persl pally Known OR-Pr u d IdenXtc
ation e/ -Personally Known OR Produced I entifi.•,tion.
Type of Iden$ification Produced Type of identification Produced
Co 'r s'sip lcfARA D HERNANDE A D HERN='D
v a�a•.y
al) Ctirjiiisvr{' Seal
• MY C F17241 MY COMMISSION
2419
EXPIRES October 28,2018 =�, EXPIRES October 28,2018
(ao7)3s811153 Floridallotaryse ice.com 407)398-0153 Floridallotaryservice com
R FRONT ZONING SUPERVISOR VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE I
RECEIVED Vl
DATE
COMPLETED
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