HomeMy WebLinkAboutBuilding Permit Application 3
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED r �y
Date:—7' 1�1� In �PYD
Permit Number: U
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ED
Building Permit Application FEB i 32017
Planning and Development Services PERMITTING
Building and Code Regulation Division St. Lu 'e
2300 Virginia Avenue,Fort Pierce FL 34982 County, FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSEDIMPROVEMENT LOCATION:
Address: ,I n I vl.Q.eXlr01!l G.1� (Uk, Q(- &1, Wot P 34
Legal Description: t' U br to_�
PropertyTax ID#: L - o - ®_2 Lot No.�
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
,T-';,s ll 2.2 �<'J '4".1 Ivy 2e r,tra. r- Z66 Q+P rico.-% Serv;Ce.
CONSTRUCTION INFORMATION:
Additional work toe performed under this permit-check a appy:
HVAC Gas Tank Gas Piping _Shutters ❑Windows/Doors
®Electric M Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ "l Iy 0• Utilities: Sewer ElSeptic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name of Q Name: 1
Address Y I dr Company: `e kci
City: l�V State: Addr ss: c
Zip Code: + Fax: E, City:Y 0 O UA-f_ State.
Phone No. Zip Code: Fax:
E-Mail: Phone MR. !S I 14QD
Fill in fee simple Title Holder on next page(if different E-Mail:
from the Owner listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
-' J
SUPPLEMENTAL CONSTRUCTION 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 recording our Notice of Commencement.
s
Signature of Owner/Lessee/Contractor Agent for Owner Signature of C tractor/ ' ense Holder
STATE OF FLORID STATE OF FLOR DA�c}
COUNTY OFI���j-Q COUNTY OF
The forgoing instr m nt was acknowledged efore me The forgoing instr ent was acknowledged before me
this JQ_day of 20 by this la day of 20 a by
L�vf V
mac, �Ca��nn
(Name person acknowledging) (Name of rson acknowledging)
(Signature of Notary Plic-State o orida) (Signature of Not P c-State of Flo 'da)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identificati Produced Type of Identification Produced
Commission No. fi5+ ommission No. - e
�rpw AV. Notary Public State of Florida
�ov^aYp � Notary Public State of Florida Antonia M Paula
Antonia M Paula �? Gemi
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1'o F.0 V ExpGes 02/27/2019 ommission FF 191201 Fo�?�oQ� Expires 02f2712019
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE 1
COMPLETE
INITIALS �i