HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: l 0 Permit Number: �r1oLf-0/n
� � RECEIVED
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 �C
PERMIT APPLICATION FOR: ��
P,RQ�POS�ED I N P�R01/EM E N O`CA 10.
Address: 3 PALS
Legal Description: /"I),AV glrl�a- LS"i', TL4C Vrd t i 8 2Z 1f
Property Tax ID#: 3C/02-. 87 -012'0 -000 j 'LotNo.27
Site Plan Name: Block No. S�
Project Name: S11I"C /ZCYLAC9MQyl
Setbacks Front Back: Right Side: Left Side:
ETA g �E-D
N •�h/ l2�s l /��t�t�L(�
CON5�TRlJ.CTIQN INF�RNI'ATI.OIV:
-
0
Acid itiona I 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: $ � • Utilities: —Sewer _Septic Building Height:
Name 0-14rj K11..y1,icI/- Name: I 4 H) OL c e,
Address: �-907 1p4e f-h Da- Company: D&Q6u-s
City: t'A;i . /p,0-AGL, State: lC� Address: P-sa 90k '797,5 )
Zip Code: 3 y I PZ Fax: City: 5"AiX') -GL.ub State:
Phone No. Y07 —7 02 Zip Code: ?V77'0 Fax: ^
E-Mail: r'ictA T s-oc.Ae.rA des►Gv1S. k-L Phone No YQ-7 -7d 9 - 5&2-l1
Fill in fee simple Title Holder on next page(if different, E-Mail d 'ion �e, iA211 d h 't-
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
S ''PPL MENTA CONSTRtJ ' I gN 111/ `NF®R+11/I TI:ON>
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 our Notice of Commencement.
X�
Signature fo Owner%Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLO IRA STATE OF FL RIQA
COUNTY OF� .\� �� 2� COUNTY OM \ C`
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of nz)!b 0200 by this day of k 20�' by
(Name of person acknowledging) (Name of person acknowledging)
(Signature of Notary Public-State of Florida) (Signature o Notary Public-State of Florida)
Personally Known OR Produced Identification ✓ Personally Known OR Produced Identification
Type of Identification Type of Ide t'fi ion
Produced c- QLkZ• duced
y „` DAWN D'AURIA ��v a DAWN D'A
to Public,State of Flor duo mission No: o Nota Public,Sta a Florida
Commission No. B,( e ry x ry
Commission#FF 17015 Commission/F 1 0158
My comm.expires Oct.20,2 18 My Comm.ex ire 0,201f
REVIEWS FRONT ZONING -SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW- REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 712014