HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MU BE COMPLE��.�.%:-OR APPLICATION TO BE ACCEPTED ` -. �� `-"®►��1
Date: � I Permit Numbr� � i
It O 0 E. F E
MAR 3 0 2017
Public Works
Building Permit Applica ionie county, FL.
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 _ sue
PERMIT APPLICATION-FOR: 4
"V� - m-, C_
PROP®SED INPR®UEMENT L®CATI®N:
Address: A31 Af /-/IeS 475 Vc_� & �.Xeoa ICA �&)!L7a�
Legal Description:
Property Tax ID#: ® q1r7 000 V Lot No. a 3 f
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF WOR+K:
$ I I
C® STR,ORR ION I INFORMATION:
dditional 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: Sq. Ft.of First Floor:
Cost of Construction:$ Q Utilities: _Sewer _Septic Building Height:
OW'N11ER/LEWSM CONTRA TOR:
Name L e, I-er K. Name: 0Lm
Address -4- Company:
City: see l tac 1 State-a Address:
Zip Code:3 Jr Fax: City: State:
Phone No. 731-tot Zip Code: Fax:
E-Mail:Zpes Z2(n 4 z2/10n w1 Phone No
Fill in fee simple Title Holder on next page (if different E-Mail lei a Y 0 f'I uhne J,
1 from the Owner listed above) State or County License
if value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
• 1; `I 1 1
SUPPLEMENTAL CONST ION LIEN LAW INF®'RMATION.
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 rion-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 inspe u intend to obtain financing, consult with lender or an attorney before
commencing workdr recordindvour Notice of Commencement.
ign re of 4W�Ues�iee/Contra-c-fo9-as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDAL STATE OY OF FLORIDA
COUNTY OF C�C,I
ThefaTgoinginstriAm nt was acl nowledged before me The forgoing instrument was acknowledged before me
thisday of 20�iby this day of ,20_ by
(Name of person acknowl ging) (Name of person acknowledging)
(Signature of NotbJyPublic-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification i Type of Identification
Produced M HUFF Produced
OSP Ue y�
Notary Public-State of Florida
Commission No. 3.*�' •= CommiIseepy FF 234730 Commission No. (Seal)
iN,T pS My Comm.Expires May 27,2019
Bonded through National Notary Assn
REVIEWS FRONT SZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
re—v. 7/2014