HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ' � Permit Number:
RECEIVED
Building Permit Application
Planning and Development Services JAIL 3 1 2017
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
PRQPQSED IM.P`ROUEMENT LO.CATIC►N � =d� 4
Address: Lo
Legal Description: 1\
Property Tax ID#: �qj4J�` a06 b L�4 - �j b`4 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back:_Right Sider Left Side:
DFAILEC? QESCRIPTION OF WORK .
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CC3(VSTRI)CTIC►N INFQRMA IQ
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._,:,k, ...... .'£.. ... .5 M6 .- :- . °'.•..�. a, fl,i,�.. _ :. .'.'. d-c.r;. ._. 1n}d',..r �va,�.' a1„'F.S .0 � £?_ �_
Additionalwork to e e orme under this permit—check a apply:
❑HVAC Ei Gas Tank ❑Gas Piping _Shutters ❑Windows/Doors
❑Electric ❑Plumbing []Sprinklers ❑Generator ❑ Roof Roof pitch
Total Sq. Ft of Construction: Vs� S . Ft.of First Floor:
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Cost of Construction:$ 1 �66 , C� Utilities: _Sewer❑Septic Building Height:
g �lE %LESS z NTRACTC}R u3 �
Name Stu u Name:
Address: 2� Company. t�i �
City: CAN State:i Address:4IR SE �SPJ Ka
Zip Code: 4� �Faax: City: � Stater—I
Phone No. — / ` Zip Code:,149� Fax-T"0° '49z
E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail.
from the Owner listed above) State or County License: ��o
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUP�?�EMENTAL CaNSTRUTION LEEN'LAWlNFORMAT{QNr' s >'
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicabl
Name: Name:
Address: Address:
City: State: City: State: I
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 i
commencing work or recording our Notice of Commencement.
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SigYaftrre of O n r/Lessee/Contractor as Agent for Owner Signature of Co ti
r/License Holder
STATE OF FLORIDA STATE OF FLOT
COUNTY OF NA C Xtl YJ COUNTY OF (1L t
The forgoing instrurvent was acknowledged before me The forgoing instrument was acknowledged before me
this day of 11 20 Lby this&day of 20�� by
QA r_JQ_
O(Naof person c no gi ) (Name of perso a k owledging)
4, 66W
ure of Notary Public-State of Florida ) (Signature N tary Public-State of Florida)
Personally Known OR Produced Identification Personally Known V OR Produced Identification
Type of Identification Pro_urpri Type of Identification
y�' rt AMANDA ;,=�Fh:?:e�c, BE V L.HADDAD
Commission No. ': , Y GOtV( gIoN is FF232750 Commission No. MY %' " CommMM #GG009363'
EXPIRES May 19.2019 :,;;F oQ EXPIR S:JUT,
u y 6,2020
°� Bonded Thru Notary Public undenw6
l4 '
Revised 07/15/20114-
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE t
COMPLETE 1Z j
INITIALS j
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