HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MIDST BE COMPLETED FOR APPdcATIbi11 TO$E ACCEPTED
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Building Permit Application-APR 10 2017
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue,Fort Pierce FL 34982
Phone: (772)462-1553 Fax: (772)462-1578 Commercial Residential
PERMIT APPLICATION-FOR:
Address: �I >.. Tl� I:. l � �- �'��✓ f- 1r.�- � t u' y4
-Legal Description:
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Property Tax ID#: 4 0 6('0 3 - 0 016 Lot No.
Site Plan Name: Block No.
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Project Name:
Setbacks Front Back: Right Side: Left Side:
�pETTAILE'D DyPE RI�PTON
�;., i,�a a.-i$. �L,'x_:� �e �_i�• _�_ _c '�+" ems:. �wf�,4-3.-�"�"?^_R v y''• �l°"'��
.Additional wor to be performed under this permit-check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
G'E Plumbing Sprinklers Generator Roof lectnc _ g _ p _
Total Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction:$ A Utilities: —Sewer —Septic Building Height
Q NER% ESSEy�� CONTRA` ®Rj..
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v..____..'•.. 4�x'$,`��
Narri-ei Name: Ov;., Ale.r,'m e, (6;,
,Adc(ress. rD. � .J T i1jOv/ d r,"/c Company:
City:, -!:r-{ I� °;rvG Stater Address: \\ A_1 a. S ��•�,`►� 57�!�P�
Zip Code: JZI`YS9� Fax: -` ��`- City: I&'! Stater
Phone No. � `7�g I- $�O I Zip Code: Fax: -
E-Mail: - ~ - Phone No 0
Fill in fee simple Title Holder on next page(if different E-Mail j c k E,,/' Z> X G-
from the Owner listed above) State or County License Rr7
If•value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
E T •• fl I� RMAT`1QN
DESIGNER/ENGINEER: Not Applicable' MORTGAGE COMPANY: _Not Applicable
Name: P_r' �' r Name:
Address: 0 i LI/✓ - a Kc 2 Address:
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Cit State: J:�7L City State:
Zip: 3 N QW L( Phone Zip: Phone:
TEE.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 our Notice of Commencement.
Signature of Owner Lessee/Contractor as Agent for Owner, S i g n at u Spoftont or/Lice DselZiffer
STATECIF FLORIDA STATE OF FLORI A
COUNTY OF S'r. LU C,1e COUNTY OF a� n
The forgoing instrument was pcknowledged before me The forgoing instryrpent was acknowledged before me .
this •If liay of 20• 4 by this 4-day of Np kMIDPi' .20_1_Lo by
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(Name of person acknowledging) (Name o rson acknowledgin )
Jed
-
gnature of No!pfy Public-State of F on ) / (Signet re of Not Pu lic-State of Florida)
PersonallyKnown O uc� 1id�P
R&10 PersonallyKnown OR Produced Identification
Type of Iden ' qti n NOTARY PUBLIC Type of Iden ' ti n
v
Produced � 1 Y'i TE OF FLORIDA Produced
Comm#FF15'1630 NOTARY PLIBLI
Commission No.�q �b -Ex(SeW)912912018 Commission No. Ef C1a0� STATE OF FL
. Carnrrd#FF921
1 `� 1. Expires 9=01
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW.
DATE y
RECEIVED
DATE _
COMPLETED
ev:
PERMIT# ISSUE DATE
- PLANNING. � .. G & SERVICES
- Building & Code Compliance Division J
BUILDING PERMIT
SUB-CONTRACTOR AGREEMENT
I
Ahave agreed to be
(Coma y Name/ divid 1 N e)
_ the / Sub-contractor for
(Type of Trade) (Primary Contractor)
16. ) T
For the project located at .0� S /1
( roject Street Address or Property Tax ID#)
It is understood that, if there is any change of status regarding our participation with the above mentioned
project,the Building and Code Regulation Division of St.Lucie County will be advised pursuant to the
filing of a Change of Sub-contractor notice.
�_X
CONTRA O S ATURE rifler) SU -CONTRACT SIG TURE(Qualifier)
P T N E PRINT NA
COUNTY CERTIFICATION NUMBER COUNTY CERTIFICATION NUMBER, II
State of Florida,County of � � State of Florida,County of� ry
r
The foregoing instrument was signed before me this day of The foregoing instrument was signed before me this 1 day of
20a by (� i"171 lC t�'1 ,20)gby 7 AIJ 16 Kz7/ /9106
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who is personally known or has produces- .�L �� �yho is personally Immvn V or has oduced a
as identificatio >�e - — - = -_ ^
CARMEN CORINA TEXIERasi tion.
'_.' °' Notary Public-State of Florida _
gig oa Coml�i,�s #FF 926877 ,
My CO�iM: ires Oct 13, STAMP
Signa e o otary Publi '�n�u�a`' gn a of Notary Pub'
'nt Name of Notary Public Print Name of Notary Public
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2�ppV Ppe`'� Bonnie L.Smes
State of Florida
Revised 11/16/2016 w9 w,a�My Commission Expires 0310112018
'�°F Commission No.FF 92432
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