HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: ��- na(l
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Building Permit Application FEB
Planning and Development Services 2017
Building and Code Regulation Division
J35RMITTIN
2300 Virginia Avenue,Fort Pierce FL 34982 rf L yale '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
.PROPOSED-lMPROVEM ENT LOCATION
Address: Q
Legal Description: 1e_
PropertyTax ID#: Y,rOa-SCJr-Ort�a GOt-_j Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
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DETAILED DESCRIPTION OF WORKk
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CC+NSTRUCTION INFORMATION `S
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Additional work to e e orme under this permit—c ec a apply:
OHVAC Ei Gas Tank Gas Piping _Shutters ❑Windows/Doors
Electric Plumbing F]Sprinklers ❑_Generator Roof
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Total Sq. Ft of Construction: IS . Ft. of First Floor:
Cost of Construction:$ '7 f L?GG 00 Utilities: 0Sewer Septic Building Height:
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OWNER/LESSEE CONTRACTOR ,
Name-- r2 Cl0 a 24Cyek7 Name: ae
Address: &30-7 Company: it
City: cfkah State:A] Address: 33git
Zip Code: 4-19113g Fax: City: 75/cX,_'4- State:
Phone No. /G f 3- Zip Code: 3ygq� Fax:"_rV '7 "?7&
E-Mail: Phone No. '77� �l
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Fill in fee simple Title Holder on next page (if different E-Mail: 1,S•C604
from the Owner listed above) State or County Li ense:
If value of construction is$2500ior more,a RECORDED Notice of Commencement is required.
ANIL
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SUPPLEMENTAL CONS1"RUCTION LIEN LAW INFORMATION. _
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DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY:* _Not Applicable
Name: Name: ( 'i
Address: ! Address: II
City: State: City: State: II
Zip: Phone: Zip: Phone: I
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FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone: i
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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.
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_Signature of n Lessee/Agent SignatL/e f C(5ntracto /License Holder
STATE OF FLORIDA STATE OF FLORIIQA
COUNTY OF r) COUNTY OF
The for oing instru ent was acknowledged before me The forgoing instrument was acknowledged before me
this day of Q 20(�by this Q, day of rOCL 20 I7 by
Yn, J,,,40_V,
(Name of person acknowledging) (Name of p r on acknowledging)
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(Signat re of Notary Public-St to of to ida) (Sig natu a of Notary Public-St to f orida)
Personally Known OR Produced Identification Personally Known �c _OR Produced Identification
Type of Identification Produced W( '-ID. - Type of Identification Produced I
Commission No. S-7f3�15 (S�)%u111111111111/Z Commission No. gZ�3�s (Seal)
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Revised 07/15/2014 e ® _ 0 ��p�»2 ,•
REVIEWS FRONT iZONIf a I PLANS VEGETATION SEAT) EJ sNVIAR
COUNTER REVIE&,�r e(�l i ���` REVIEW REVIEW REV G•-. ststeR
DATE Titi
COMPLETE
INITIALS �
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