HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLET FOR APPLICATION TO BE ACCEPTED r--� C
Date: �T Permit Number: L O�� J
CEIV
FEB 2 2 2017
Building Permit Application PER,,-A,TT ;;:,
Planning and Development Services St. Lucie
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:
PR®POSED )'NPRO� EMENT'LOCATI'aN: �J I�
Address: FJE7,71 i � (ZCG
Legal Description: ,���w �J ivy Z �5<<�"z�-� tJ < < 13- {G
Property Tax ID#: -3`f C)I- 66R- d 7_3I ' QQ0_d Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETA LE� DE�SCR�I�PTION OF WORK:
.5,D,"4 0 J3 C\.x --7- 11
�@�N,8TRfUCTION 1,NFORMATPRO
Additional work to be performed under this permit-check all that app y:
_Mechanical _Gas Tank _Gas Piping _Shutters ✓Windows/Doors
Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $ Utilities: _Sewer _Septic Building Height:
1NER/IE;W E: CONT C 1'R:
Name j� ..R�r1.t 3�,�I�Jla3 Name:r
Address'' s�SfG cGkd izY ��U� Com ariei� 2( Y���•J J �,�5�p fir: Zyc no
City: VO zN 1��G State: f:�/ Address: 9�•C) • ��� I �' ��
Zip Code: 3 q q`v Z Fax: City: 1TJ�z-� �C ►�`iz� State: .
Phone No. 9"?U 5 19 - 61?6 Zip Code: 3(49 7"t" Fax: `79Z-4/60-a3 Z,5—
E-Mail: Phone No
Fill in fee simple Title Holder on next page ( if different E-Mail 42 �v��a��q Z`{ @. t3�1( SouA SET
from the Owner listed above) State or County License C1Z,C. 13 Z IZ9
Lvalue of construction is 2500 or more,a RECORDED Notice of Commencement is required.
i
SUPPLEMENTAL C®'NSTRLt ffil N LIEN LAW INF®RN1A1't'ON: t
a
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:
OWNER/CONTRACTOR AFFIDVIT: Application is hereby made to obtain a permit to do the work and installation as indicated.
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 pro erty. A Notice of Commencement must be recorded and posted on the jobsite
before the first inspection If you intend to obtain financing, con le an attorney before
commencingwok or rec rdin' our Notice of Commencement.
/J_ <
Signature owner/L ssee/Contractor as Agent for Owner Signature of Contract r/ 'cense Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF --'-4 `Q. COUNTY OFF�� ),0—,
The forgoing instrument was acknowledged before me The for oing instrument was acknowledged before me
day of 20 �- b
this day of��'��7 ,20 1—� by this, y �P�J L. Y
(Name of person acknowle Bing) (Name of person acknowledging)
(Signature of Notary Public_State r
ori a) ( re of otary Public-stiteo F on a
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identificat}bn ,�r►n,� A.GOODMAN Type of Identification 'pAy,�,�� B�RAA.G�,�
Produced �O BAOMRA Produced + '••
' Y COMMISSION t FF 101341 Y COMMISSION i FF 101341
*1 * 4rv8udgdN*WySMIC"
ES:March 12,2018 1 *� * EXPIRES:Match 12,2018
Commission No. °�q ep"�►y0� Commission No. \C)� 1 R01 gdd IJBuegetNoreryserv►ces
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.