HomeMy WebLinkAboutBuilding Permit Application AII'APPLICABLEE INFO MUST BE COMPLETED FOR APPLI6ATION4TO BE ACCEPTED.
Date: d 'a�• )'] Permit Number:
a�
------ RE ' IED
Building Permit Application
. 2017
Planning and Develop►nent Services
Building and Code Regulation Division
2300:Virginia Avenue,-Fort Pierce FL 34982 .
Phone: (772)462-1553 Fax: (712)462-1578 Commercial Residential '=
PERMIT APPLICATION FOR:.ti
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PRC}PC$3Sf)DCNPRU�/EME
Address:%/ fix.+ GruS �cr�_;I �`�c� ' 1�.,r r P �..
Legal Description:
Property Tax ID#: Lot No. 2 _
Site Plan Name: Block No.
-Project Name:. Le.l4X 1..9®�c� PP
LC
Setbacks Front Back:. Right Right Side: Left Side: -
DE7'AIl.ED DENS R+f�PTI®N OF WOR+K:
b p n cA- : n on
BOCIA feral �n rem`a\Ie_A
CO STR�UCTIO I�NF®R=NATION:
Additional work to be pertormed under this permit—check all,.that apply:
Mechanical -Gas Tank _Gas Piping ': Shutters `. Windows/Doors
Electric _Plumbing _Sprinklers ;:Generator Roof. Pitch
Total Sq. Ft of Construction: 6 d Sq. Ft. of First Floor: 14
Cost of Construction $ _ ' Z.H q:5. 00 utilities: Sewer _Septic Building Height:
_' 0 NER/LE��5 �E• CONTRACT® R:
Name - i/ +sgrvi ca+n Onasovq Name:
Address: Company:
City: iN% State-f1fa, Address:
Zip Code: Fax: City: State:
Phone No. '7 �ya.—V39 Zip Code:; Fax:
Phone No E-Mail: -�'w�Z. � �rr,� i - i1 _ '
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..
S PLE =� 1`Af.CaNS� a.U:C IQN LIEN L.AUV 1N -OR+MATlt3t�:
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: cbn ,� t1C,cr4eS ��c . Name:
Address: QD%:641 _ �`" Address:
City: • l State: City: State:
Zip: ,2C'G!&7 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 property. A Notice of Commencement must be recorded and posted on..the jobsite
befor&the first inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording • our Notice of Commencement.
,.Signature of Owner/Lessee/Contractor as Agent fo wner Signature of Contractor/License Holder
_STATE OF FLORI A _ rN = STATE.-OF FLORIDA
_U_
COUNTY OF � o COUNTY OF -
_ a
The forgoing instrument was acknowledged before LW Z The forgoing instrument was acknowledged before me
thisspL day of 0 by ¢oX this day of 20_ by
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(Name of person acknowledging) '' _ (Name of person acknowledging)
(Signature of ary Public-State of Flori ) (Signature of Notary Public-State of Florida)
Personal) now OR Produced Identification Personally Known OR Produced Identification
Type of Identificati /J Type of Identification
Produced !/v' Produced
Commission N (Seal) Commission No: (Seal,).__
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE : MANGROVE
COUNTER REVIEW REVIEW t�REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
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