HomeMy WebLinkAboutBuilding Permit ALL APPLICABLE INFO MUST BE CON TED FOR APPLICATION TO BE ACCEPTED
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Date: • ';j - �T Permit Number: / ZO'7-
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Building Permit Application ED
Planning and Development Services JUL 2 5 2017
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: To Select from dropbox, click arrow at the end of line t-V
PROPOSED IMPROVEMENT LOCATION:
Address. _ W T� �T►i�, - t I 12i 2 '�1 - -
Legal Description: IJQ (� �A!'F�� i � /U I
Property Tax ID#: �3 1)b1(nI (X) S� Lot No.
Site Plan Name:C 4� 12A E Block No.
Project Name: LAG Lz✓� f
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:7 2 Sp 11" ' M,
Additi8nalw6rto r Orme under this permit-check all appy:
HVAC Gas Tank [:]Gas Piping ElGenerator
Shutters Windows/Doors
OElectric ElPlumbing OSprinklers [2-RRoof pitch
Total Sq. Ft of Construction: i S06 S . Ft. of First Floor: t �jU n
Cost of Construction: $�(�'��`�]�'�j Utilities: Sewer Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name 11)eov 02 1?& �'T1 ..�,.ddJA Awe: JCC_
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Address: Company:t�llns - 44 C,
City:_r-(2i,C CC a State:_ � Address: ( ' t 56- Mr:A__nW
Zip Code: 14 2 J9 Fax: City: -fir Cil3l State:
Phone No. b3 `NZip Code: l62— Fax:
E-Mail: ki Phone No. -nZs
Fill in fee simple litle Holder on next page ( if different E-Mail: (-� ��1Q
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTII LIEN LAW INFORMATION:'
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:
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 recordin your Notice of Commencement.
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Signature of Owner/Lessee/Contractor as Agent for 0- Signature of Contra or/License Holder
STATE OF FLORIDA (? > ,� '_i STATE OF FLORIDA j
COUNTY OF d fes/ COUNTY OF � ( C'
The f g instr nt as acknowledged befor rg„� The forgoing inst ment was acknowledged befor
this day of 20y a � y
z 9 this da of 20 by
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m cnm vmC=
f 2 Q�z r_
'o n Y',
(Name of person acknowledging) a p (Name, person acknow edging)
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( gnature of ary Public-State of Florida ) (Signature of Nota ublic-State of Florida )
Personally Known_ OR Produced Identification Personally Knowny OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (Seal) Commission No. (Seal)
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE d
INITIALS