HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED J )
Date: Permit Number:
RECEIVED
Building Permit Application JAN 31 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: To Select from dropbox, click arrow at the end of line
PROPOSED 1MPROIEMENT LO'CATI'ON Y ''
Address: �?D�.� �1`N ` � c10 � Cta �a.,. ���G ,�`,
Legal Description:
,Property Tax ID#: `,�03"00=1- OO®—.4;;r Lot No. 1�
Site Plan Name: Block No.
Project Name: 1 1T eg,V r�ells,
Setbacks Front Back: Right Side:J&5l Left Side: I
DETAILED DESCRIPTIONF 1NORK
,��t���w�� NFAN \t��oy�►� COL � �pn, w���. �.vti� Gf�G4. uv iQ���r�S
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cCINSTRUCTIQN IN.FO IUTAT RIOzN
Additionalwork to e e orme under this permit c ec a a apply:
�HVAC E] Gas Tank Gas Piping In Shutters ❑Windows/Doors
Electric ❑ Plumbing Sprinklers ❑Generator ❑ Roof
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction:$ •i- '��✓" Utilities: Sewer Septic Building Height:
OWNEE ., CONTRACTO ER/LESS R, T
Name Name:
Address: A"; v ,o c'c.� ���,e��, ��¢� Company:
City: �nrN4 S0cg1% s State: Address: an3\ % I,, �e
Zip Code: �,3o- f Fax: City: �hkwv State: L
Phone No. °` s-&Q Zip Code: 3NJI, Fax: 'IWt-
ti,n
E-Mail: Cows < ���m�7 vqr a. L hone No. — 1 —07 99
Fill in fee simple Title Holder on next page(if different E-Mail: Mi r iv 21Q Vnl;;A
from the Owner listed above) i State or County License: G7>G lzz"O!q
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
I
SUPPLEMENTAL Ct)NSTRUCTIN LIEN LAW INF-ORMATIQN
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:
I;City: City:
'Zip: Phone: Zip: Phone:
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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 recorde and posted on the jobsite
'l before the first inspection. If you intend to obtain financing, consult with lend r or an attorney before
commencing work or reco ur Notice of Commencement.
s
_Signature of Owner/Lessee Ag Signature of C. ctor/Li 6 e Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF ��LJt'I � COUNTY OF C
The forgoing instrument wa cknowledged b fore me The forgoing instrument w,a`s acknowledged before me
this day of �T1�e 20by this day of �6�N 20 by
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(Name of rson acknowl dgi g) (Name of perso cknowle n )
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IA
(Signature of Notary P li S F orida) (Signature of Notary c-S of Florida)
ayi%;;a.�,vcJ9$$9e'�
Personally Known OR d � ��r►tt it i6n rr,,, Personally Known 0 roduced;lcl��ti�ia � f
Type of Identificati Produce _��Q;° �SSI�NPXA°° %< Type of Identificatio Produced e`�'`��`' °•°°°•° `°rr
e
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Commission No. .t eall Commission No.
#FF 083� 5 o U ® 0 34 o
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Revised07/15/2014 '✓+ �etgic�stP� �°,9yp �N�rs ,�o�`�,�.,
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE I,.A L
INITIALS