HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
WOR E C E I�, 0 APR 2 6 2D17
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 1/
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION:
Address: 10� GeC�
Legal Description: �-
Property Tax ID#: n/1 Lot No.
Site Plan Name:- �LL� �/�S /i /Q ! i L� Block No.
Project Name: r• k d
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WORK:
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CONSTRUCTION INFORMATION:
itiona work to bfelertormed under this-permit-check all apply:
�HVAC �yGaTank ❑Gas Piping _Shutters Q Windows/Doors
_Electric Plumbing Sprinklers I Generator E] Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor:
Cost of Construction:$ �'�'S'S . �/ Utilities: I"1 Sewer E]Septic Building Height:
OWNER/LESSEE: CONTRACTOR:
Name Mac,a Name: J1 C o
Address:96'-7) S. 0 c c� !`_ �� r. a/O Company: Fhua
`c C,`l1
City: \,)p R 6�__ State: Address: V 1/
Zip Code: Fax: City: )` P'c State:
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Phone No. :4 CL5L 53 F-D- Zip Code: 5 K S7 Fax:
E-Mail: Phone No. - -
Fill in fee simple Title Holder on next page(if different E-Mail 1��f►P,e t I LO > idyl I F1�°�nlhu
from the Owner listed above) State or County License 1 D I
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
SUPPLEMENTAL CONSTRUCTION LIEN. LAW INFORMATION: .
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:
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 wit Ml er or an attorney before
comme in work or recordingour Notice of Commencement. / �
s
t re o Own Less /Contractor as Agent for Owner S gnature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF COUNTY OF =776t
The forgoing instrument was acknowledged before me The forgoing instru nt was acknowledged before me
thisaL day of i 20 Lby this2 day of Ul r 20 /7 by
Q r'f`! S YYCE Yi C ew� YJY7.t l�l�'0
(Name of person acknowledging) (Name of person acknowledgin )
0""�a 4
(Sig ture of Notary Public-State of Florida) (Sigr ture of Notary Public-State of Florida)
Personally Known ✓ OR Produced Identification Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced JULIANNECOLELLO
a:rd®! �R1�IANNE COLELLO ,r * MY COMMISSION#FF 136715
Commission No. �3 5 IMMISSION#FF136715 Commission No.�f/3C7IS ealjkXPIRES;July21,2018
EXPIRES:July 21,2018 4�OFFL�P\ Bonded ThruBudgofttorySorvlon
'� �IlruSud etNota Services
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE �,1 'nT
COMPLETE 1
INITIALS