HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COI,D FOR APPLICATI01�'TO BE;ACCEPTED W
Date: �' /• �`�. Permit Number:
Building Permit Application APR / 7 2017
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,'Fort-Pierce-FL-34982
nt,--.. /7711 AG')_ICC4 Cam.,. 17711 AC,a_ls7Q rnmmarrial Residential
PERMIT APPLICATION FOR:
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Address: rw\
Legal Description:
Property Tax ID #: 1 J o l 6 4 ''(a I o1 —oar) r $ Lot No. 2S
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Site Plan Name: Block No.
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Project Name: k,r\P &'87 W 0 D
Setbacks Front Back: Right Side: Left Side:
Additional work to be pertormed under this permit —check all that apply:._
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _Windows /Doors
_ Electric _ Plumbing _ Sprinklers —Generator _ Roof Pitch
Total Sq. Ft of Construction: Zq 5, Sq. Ft. of First Floor:
Cost of Construction: $ l O0 0 Utilities: _ Sewer _ Septic Building Height:
Name 0 L(11YVA n%0,V/
Address: �-50 S Ccq'J%YyG V P_
City: �=O�t �� e:Y-LC'2 State: CL
Zip Code: Cl Fax:
Phone No. J-Cl Oa
E-M a i I : 1 c� (�„ems 1'� ia2 2tt (E7
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name:
Company:
i
Address:
City: State:
Zip Code: Fax:
Phone No
E-Mail
State or County License
if value of construction is 2500 !or more, a RECORDED Notice of Commencement is required.
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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 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 your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Own
=:
ature of Contractor/License Holder
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STATE OF FLORIDA
m
S
TE OF FLORIDA
COUNTY OF
mQC
UNTY OF
The forgoing instru ent was acknowledged before me
9
Tbi
forgoing instrument was acknowledged before me
2 �
o v
this i-� day of 20by
ti
day of , 20= by.
Name of perso cknow ledging)
(N a of person acknowledging )
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State of Florida )
Personally Known OR Produced Identification
Personally Known OR Produced Identification
Type of Identification
Type of Identification
Produced YY% )C i Ld PAJJ�
Produced
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.