HomeMy WebLinkAboutBuilding Permit Application s - �
ALL APPLICABLE INFO MUST BE COMI�LETED FOR AP�P/LICATION TO BE ACCEPTED
Date: / �(,3• l ! `x. ��V l%'l Permit Number: �� I
Q302YJ/ R E C, E
Building Permit Application JAN 2 6 2017
Planning and Development Services
Building and Code Regulation Division V
2300 Virginia Avenue,Fort Pierce F134982
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 IMPROVEMENT LOCATION:
Address: i L� OP 2-r(s Ch-A- q-c" _ C_Jr 7'Q P'" C.C.-f-'4 FL '�q 9 L4 9
Legal Description: ur.r_nS (-,8U t 1 k 17 L6
PropertyTax ID#: In Q I F s 0 0O Lot No. A
Site Plan Name: Block No. 17
Project Name:
Setbacks Front �` Back: Right Side: 0 Left Side: 1 P1•
DETAILED DESCRIPTION OF WORK:
3,T!r/x-2 ; pod F_MJ69L-,, dr1 E;S,1 :n)
CONSTRUCTION INFORMATION:
Additional wor to be nerformed un er t is permit—check all tbat appy:
HVAC Gas Tank ❑Gas Piping _Shutters I]Windows/Doors
1 Electric Plumbing Sprinklers 1:1 Generator 11 Roof Roof pitch
Total Sq.Ft of Construction: Sq.Ft.of First Floor:
Cost of Construction:$ �.�a I. Utilities:11 Sewer Septic Building Height:
OWNERAESSEE: CONTRACTOR:
Name 1=u e,1y,, S A. " Name: �P
Address: C_� Company:
City: Stater Address: �3 t S_ d5 f-�—KA-
Zip Code: Lf Fax: City: 9V-tY2e_ State: �C
Phone No. j �3 — 0 � Zip Code: 3�Pc1 Q'i Fax: �4 —So
E-Mail: Phone No. �1'1 1 34S—is R-0 5'
Fill in fee simple Title Holder on next page(if different E-Mail: 89 LA,_QL e-4
from the Owner listed above) State or County License: ' 2
1f value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: —"'Not Applicable
Name: &i4 Oun Name:
Addre : 15'1 % C2rvc,,lnsf-'� Address:
City: - State:__EL, City: State:
Zip: Phone: - Q 44 Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ of 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 roperty.A Notice of Commencement must be recorded and posted on the jobsite
before the first insp ion. If you intend to obtain financing,consult with I er or an attorney before
commencingwor o recordin our Notice of Commencement.
s
Signatur Owner/Lessee/Contractor as Agent r Owner Si t e of Contractor/License Holder
ST E OF FLORIDA STATE OF FLORI A
COUNTY OF &v-'t Sk L r 4 COUNTY OF Pn vk SA-
The
A-The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this,,L day of -e.v.u c, , 20 Eby this_,2e day of ,20 (Z by
Ori-h Z A (- !M (� .e( A r,-6► a J I= PN
(Name of person acknowledging) (Name of person acknowledging)
L� b_/6-QL Q'__- , c,,-/-A
(Signature of Nilitary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification-✓
Type of Identification Produced qQL_,r Type of Identification Produced
Commission No. ? Commission No. S
CINDY L ALCHERMES CINDY L ALCHERMES
_State of Florida ;b`"aVP�B���-
'=o° :`= Commission#FF 21031111
ti 2p19 s` Commission#FF 24i--
Revised 07/15/20 , t o`c My Comm.Expires Jul
Assn. MY Comm.Expires Jul 6, 20i
« , o hrough National Notary�A �tl, n
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE i 7
=INITIALS