HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �� Permit Number: a
V. *-,- __". RECEIVED MAR 2 8 2017-
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
PROP05ED IMPROVEMENT LOCATION,
Address: l ^1 1
Legal Description: A 1
Property Tax ID#: 1_Q Q ( L) % Lot No.
Site Plan Name. r1mn iLA Block No.
Project Named Q CLA'U Y l
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION ;OF WORK r
. ..5. .... .... .: .
60 a,-A Poo
CONSTRUCTION-INFORMATION
Additional work to be nerTo—rmed under this permit—c ec a apply:
E1HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
Electric Plumbing F]Sprinklers F�Generator F� Roof Roof pitch
Total Sq.Ft of Construction: S Ft.of First Floor:
Cost of Construction:$ �{ S C� Utilities.
�Sewer Septic Building Height:
OWNER/LESSEE _ CONTRACTOR: ..
Name 1 V .. . Nam
Address: ux U kft Company: C) I )
r\
City: � Stat Address
Zi 'Code: y- Fax:° Cit /QJl Stat
Phone No. ' -_ �;1..Gy.._ c�-�-5 .� Zip Code: �y"7R c� Fax:
E-Mail: Phone No. 1 �;A
Fill in fee simple Title Holder on next page(if different E-Mail: 11L G1 C CLO
from the Owner listed above) State or County License: C t� �1�J VDU
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
,SUPPLEM�NTA!CONSTRUCTION LIEN�'LAW ItUFoRM/�TIONF� �'���� � *�d,�� �K a„ '�
s
DESIGNER/ENGINEER:. �.•t�� ° 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 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 1rispection. If you intend to obtain financing, consult with lender or an attorney before
commencing work o _recording our Notice of Commencement.
s
Signature of Owner/Lessee/Contractor as 4en for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S�r . L y c vk COUNTY OF
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this'ZA day ofV% .fie 20AJ_by this day of At 20 by
(Name of person acknowledging) (Name of person acknowledging)
et" Zw
(Signature of Notary Publi&JIState of Florida) (Signature of Notary Public-State of Florida)
Personally Known i fgraNENS Personally Known OR Produced Identification
Type of Identification Pr a 'U
Yp I#� �`-` wAISS1 00022023 Type of Identification ro uced
EXPIRES:December 16,2020 rdAEL%. Jt I'AULA ARIAS
Commission No. C W• o;.j Bondpealy ota Commission No. Nowy(IFO7D-State of Florida
•= Commission#GG 062264
�S
Bonded through National Nolary Assn.
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE
INITIALS