HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETE OR APPLICATION TO BE ACCEPTED
Date: 2-7 Permit Number:
RECEIVED MAR 2 '72017
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: 4
PR®POSED INPRM/EMNT LOCATION:
Address:
Legal Description:
Property Tax ID#: ���a" saa'- 06� !- 600—a Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
® TAILE® DESCRIPTION OF UUO'R
�o v 1�
�. ✓t r
CD`NSTRUCTION fNFO'RMATL®'N:
Additional work to be pertormed under this permit-check all that apply:
_Mechanical Gas Tank _Gas Piping _Shutters ' _Windows/Doors.
_Electric _Plumbing _Sprinklers _Generator _Gioo
Total Sq. Ft of Construction: a SU Sq. Ft.of First Floor: SO .
Cost of Construction:$ z D 05 Utilities: —Sewer,. _Septic Building Height:
' = 011U1 'ER/LE�S�SE�E: CONTRACTOR:
Name e_``f Name:
Address: S Company:
City: State: Address: //
Zip Code: G�_ Fax: City:T s-�� State
Phone No. U (� Zip Code: 3Y z Fax:
E-Mail: Phone No `77� `�0
Fill in fee simple Title Holder on next page(if different E-Mail
from the Owner listed above) State or County License LC c_ �
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
I
Amok
SU'PFLEMENT/ L !RU!1C1"I®N LIEN LAW I'NF®' I\/[:=ATI®N.
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 concurr.ency,review:room additions,
accessory structures,swimming pools,fences,walls,signs,screen-'rooms and accessory uses to another non-residential use
WARNING TO O R: Your failure to Record a Notice of Commencement may result in your paying twice for
imp rove men o i rroperty. A Notice of Commencement must be recorded and posted on the jobsite
before the r i ctio . If you intend to obtain financing, co th lender or an attorney before
commen 'n re ordin our Notice of Commenceme
Signat er/Lessee/Contractor as Agent for Owner Si e f Contractor/License Holder
STATE OF FL RI A STA OF FLORIDA ,
COUNTY OF �•\� CO TY OF S�f•1=U�\e
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this`1L day of Vim®.-,r ,20_4 by this ZA day of 'X O r` 20� by
f ts�c 3'q
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary P blic-State of Florida ) (Signature of Notar ublic-State of Florida)
Personally Known roNrti�iGfY 'Ei Personally Known .••;G9 ,k'ro u
Type of Identificat r�` "= MY COMMISSION#GGU22D23 Type of Identification ''_' �_ ANNA IEGNENV
Produced �' EXPIRES:December16,2t120 'a ;*; MY COMMISSION#GGAZ2023 `
:a ryP-"!-11. . Titers Produced ;` '`' :De
-+ o.
o.' Ronde '••.Q ;°••'� Bonded member 16,2020
. Thru Nota
'•.�occ�•• �,�,,,�,v...;rw 7+F'ublic UnderwdterS
Commission No. (Seal) Commission No.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 7/2014