HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFOMUSTU//ST BE•COMPLETED FOR APPLICATION TO BE ACCEPTED �f /
Date: /' DR�om' / Permit Number:M .
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Building Permit Applicati®n RECEIVED
Planning and Development Services
Building and Code Regulation Division JAIL 2 4 2017
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from drdpbox, click arrow at the end of line
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PROPOSED INiPROUEMENT LO;CATIO�N x
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Address: 3 SS
Legal Description:"CS �.� �pr.�0 6,Q, io-7 ?Cyw� ?JS7m
Property Tax ID#: Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK
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CNSTRUCTIC)N IN1=0RM4TI�IV
Additional work to (eerformed under tispermit-c,elk all appy:
1_1HVAC LJ Gas Tank F_]Gas Piping Shutters E]Windows/Doors
11 Electric ❑ Plumbing Sprinklers 11 Generator FIRoof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ 'I.-AkkO .c-,C:> Utilities: Sewer Septic Building
Height-0 CONTRACTOR
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Name e. blte Name: RC747._
Addressr3S8 I,Let V_G 13\v-d. Company:Cr,
VLL-
City: State:Fk Address:!_ej 1 a tu�pe_ p2
Zip CodeZJ� '4 ~1 Fax: Cityy- .���+trt,+._ StateVk
Phone No.'-%"I;?-OCob-t- 'JA Zip Code:ZPASZ Fax:
E-Mail: Phone No." -0,L �LQb•�1uk`1�1
Fill in fee simple Title Holder on next page(if different E-Mail:S���'� &-b -V.,&
from the Owner listed above) State or County License:S?28AS0
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name:'5K�e. lu_xx�c4. Name:
Address. Sly 5AkorN vZZ%x_ Address:
City.?)t. C_ State:vrA City: State:
zip:54965 P h o n e:-11 ZLd_-j, LM 4- Zip: Phone:
FEE SIMPLE TITLEHOLDER: _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 theermit holder to build the subject structure
which is in conflict with any applicable Home Owners Association rules,bylaws or an9covenants 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 your Notice of Commencement.
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Signature of Owners—see/Contractor as Agent for Owner Signature of Contractor/License Hol e
STATE OF FLORIDk� STATE OF FLORIDA,,.
,
COUNTY OF COUNTY OF be-,114
The for ing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this iy-day of '_"T6rwA*rj 1 20 Eby this -2 Iday of 120 M by
&6Fl i2rpt' - S C_4P .
(Name of person acknowledging) (Name of person acknowledging)
5��51�' ca441-1�cf
(Signature Notary Public-State of Florida) (Signa tPa 1\166rrrublic-State of Florida
Personally Known OR Pr(;,duced Identification Personally Known OR Produced Identification
Type of Identification Produced J-.3t, A.&-Wam Type of Identification Produced C>O."4419 14elCM,
BEM.nNo. r—r-7-91
R r K (Seal)
Commission No.FF 146t JOSEPH &
',v11'C0MMISSICN#FF241794
EXPIRES June 27,2019
Revised 07/15/2014 )401)35; FlondallotaryService.com JOSEPH BECK
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My COMMISSION#FF-241794
vll�* Ext-RES Ane 27,2019
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETA1EU13-98';I-M-A ul Mton
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