HomeMy WebLinkAboutBuilding Permit Application " � A
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ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a \zPermit Number: k-\ °, �a31
.�, RECEIV7D FEB 10 2017
Building Permit Application
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 JC Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line S u r c o0
PROPOSED 1ORO, EME.NT LOCATION
Address: LA'IUG' V I.ST--A 1A,,c.- 1 105-
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5Legal Description: u-A St" L-V C-JL- 19t.X& t'o UNIT (C�6-
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Property Tax ID#: 3 (22 -5700 - Q0-75-- 000&,:, Lot No.
Site Plan Name: 6PI 51: I L4, Block No.
Project Name: G A-5(:�-(LL.-
Setbacks Front /n✓ Back: ^'� n' Right Side: N�A Left Side: �+ �
DETAILED DESCRIPTION OF WORK
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Additional work to b
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orme under t is permit-check a appy:
❑HVAC
x
x
❑Gas Piping in _Shutters Windows/Doors
11Electric ElPlumbingSprinklers ❑Generator '0-_Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
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Cost of Construction:$ SSoo— Utilities: _Sewer Septic Building Height:
A:OWNER/LESSEE CC3NTRAGxTOR "
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Name ASLIL4, ti L(NO Name: le-P -am 6" C.-,/N
Address:: big3 5 E P4iiiE «-E Company: )jgW&, Tt� /'IUt41a4M
City: pje2 - S< (_Jury State:Vic. Address: I77,v NW 6MQ?/.irt AAW
Zip Code: ?Kq c?23 Fax: City: 754V*Ui.r State:V�t-
Phone No. 5 Z$ - 4.Iw l Zip Code: 3v98y Fax: Ly2=C17Y'7
E-Mail: 641S(4u, e 'lJEt,t.TQzT3N . rgp-r Phone No. &9:2 o0q
Fill in fee simple Title Holder on next page (if different E-Mail: M�G�/'rYE�-C. �✓��� VAS ��i.
from the Owner listed above) State or County License: ['�C / -o f3 �!if value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
81IPPLw NTAL CONSTRUCTION L1e LA1N INFORMATION ; F
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 thepermit 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 fai ur Record a Notice of Commencement may result in your paying twice for
improvements to yo pr er otice of Commencement mus recorde n osted on the jobsite
before the i s cti . I y ' tend to obtain financing, con It it lend r o n attorney before
comme n w r or r co di our Notice of Commencemen .
I s
Si nature pf Owner/Le a Cont ctor as Agent for Owner Signa ure of Contracto icense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF
The for o,'ng instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of d 20/;'*'by this*�8ay of 20/�by
(Name of person acknowledging) (Name of person acknowledging)
(Signature otary Publl -State of Florida) (Signatur otary Pub Ic-State o�-Florida)
Personally Known 1,e< OR Produced Identification Personally Known_�OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. Commission No.
°i'''• ANN M.GAUMOND rq�• v ANN M.GALIMOND
�q. MY COMMISSION 0 FF 173907 '•: h = MY COMMISSION IE FF 173907
'�•. A� EXPIRES:December 7,2018 ':',�,'•'' ?':•' Bonded Thru Notary Public Undenvrders
Revised 07/15/20 Af,1?�` Bonded Thru Notary Public Underwriters
Revised 07/15/]20 af,4P4F
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS