HomeMy WebLinkAboutBuilding Permit Application t
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED �7
Date: `'1 ' L Permit Number: `V
II
Building Permit Application MAR 2 2 2017
Planning and Development Services .F
Building and Code Regulation Division P cie ICo in4,
2300'Virginia Avenue,Fort Pierce FL 34982 St. Lucie County, FL
Phone: (772)462-1553 Fax: (772)462-1578 Commercial, Residential
PERMIT APPLICATION FOR:
PROPOSED 1R�IPR01lEME NT �OCAtIQN ,:'
,
Address: A- Z
Legal Description:
Property Tax ID M M2 —C Q 7 10 16 4 GOO Y Lot No._—�
Site Plan Name:_ Block No.�(-)
Project Name:_
Setbacks Front Back: Right Side: Left Side:
DETAILED DEC►CRIPTION 0`F WORK
Ilk� to iak% \2c� C�'l.i� k.� �� �R�`>_L
iAd Ar 1..10�Q1- �� s.
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CONSTRUCTIC)N INFORMATION;
Additional wor c to be pertormed un er t is permit-check all that apply:
_,HVAC ,Gas Tank —Gas Piping _Shutters Windows/Doors
_Electric _Plumbing ^Sprinklers _Generator Roof Roof pitch
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ Utilities: ^Sewer _Septic Building Height:
OWNER/LESSEE
.�r CONTRACTC)R s
E
Name
Address:�S_20) Company:
City:-r�'O e e +State: f Address:
Zip Code:::�W Fax: City: State:
-Phone-No.� Z�� � E -Zip-Code: 7, Fax _
E-Mail: Phone No.
Fill in fee simple Title Holder on next page f if different E-Mail:t
from the Owner listed above) State or County License:
Ifwalue•of construction.is$2500 or more,a RECORDED Notice of.Commgncement.is:required.
SUPPLENIEN TAL CON5TUCTIQ�I LI .IV LAW fNFORMATION
DESIGNER/ENG[NEER: `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.-Amend ments.
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
-commencin -work-or-recording� our-Notice.-of*Commencement.
•
S
Signa a of owner less a Co r s Agent for Owner Signature of Contractor icens o er
STATE OF FLORIDA STATE OF FLORIDA
MU NTY OFF- j U ca.�P COUNTY OF 62--V k-i' l�
The forging instrument was acknowledged before me The forging instrument was acknowledged before me
this�ry day of FH�'-J=e201--L-by this day of &LA'L0_Ak 20 L� by
(Name of person a knowledging) (Name of person ack owledging)
( ignature of Notary F'ubl�tate of Florida) (Signature of Notary Public-State of Florida)
Personally Known�OR Produced Identification Personally Known )R Produced Identification
'Type of Iden ' Type of Identification 4Produced
MADE LA LUZ VELASCO ,y�
Commission _o. .r SSION f(W60399 com i " k MA DE W LUZ VELASC(� al)
Aot EXPIRES November 28,2020 •'=MY COMMISSION S GG050399
EXPIRES Novo
Revised 07/15/2014
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REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIE REVIE REVIEW REVIEW
DATE
COMPLETE -Z
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INITIALS