HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a�1��1_ Permit Number:
RECEII°rD MAR 2 7 7017
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Building Permit Application
Planning and Development Services
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
PR,OPO$ED IMP;ROVEM:ENT.LOCATION
Address: 1040 PGlb:t-V/' JC_4A-T� F+• A- � PL • 3M 5
Legal Description: 17 35 �3q i�7 Y7 o r N vz aF nl Yz- Or /VW Irq nF IV(/J —LESS'
ZJo3 1 2- F-f' - C31-0q AZ) (02. f QS- M! )
Property Tax ID#: Z_319 — 22-1 - 0020 - 0t)014 Lot No.
Site Plan Name: ODI 0 Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DE OF SCRIPTION�: WORK
CONSTRUCT,I,ON LN-FORIV*iON
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Additignal work to e e orme under this permit-check a ap p y:
LJHVAC Gas Tank Gas Piping _Shutters 1&ndows/Doors
Electric LJ Plumbing Sprinklers El Generator 21 Roof Roof pitch
Total Sq. Ft of Construction: 3,40 S . Ft. of First Floor: -3 �
Cost of Construction:$ �Ot1 Utilities:Sewer Oseptic Building Height:
O,V1/IVER/LESSEE CONTRACTOR:
Name QeAf A . HAN Name: DA
Address: 0 0 puk, zC—_ &,+b Company:
City: State: R- Address:
Zip Code: 3 — Fax: City: State:
Phone No. — DIOS Zip Code: Fax:
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:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION;
DESIGNER/ NGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: Name:
Address:
Address:
City: e C— State: City: State:
Zip: Phone: -- 179K. 8 Zip: Phone:.
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: I—oxGv— ,AW Name:
Address: loVo Pu,617f�- fhb Address:
City: F+, t�CR-c�L— City:
Zip: 3 — Phone: —a O 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
commencing work or recording our Notice of Commencement.
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLOIUDA STATE OF FLORIDA
COUNTY OF Sl - L-AA—CZ L COUNTY OF
The forgoing instrument wa§acknowledged before me The forgoing instrument was acknowledged before me
thiQQ- day of 20 VI by this day of 20 by
(Name of person acknowledging) (Name of person acknowledging)
(Sig ature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known N— OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced
Commission No. (( INEDOLBASHIAN Commission No. (Seal)
t *MyC�oMMISSION#GG007608
Nr c� EXPIRES:October 14,2017
Bonded Thtu Budget
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE II
COMPLETE t'I`I2�1 l h
INITIALS
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