HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE CO LETED FOR APPLICATION TO BE ACCEPTS I�
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Date: Permit Number:
o
j 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
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IMPROVEMENT LOCATION.:
Address: 17103 a c i i c, 4ve r-'r i`e-r-c e FL 3 4c/5�
Legal Description: L--CLIef W 00 d Paf fe- --u A + 1 I 14 7 1-0T /,9021J
o g b'l9- 3l�Cv�
Property Tax ID#: 30/-(,13- C>23'7- O UO Lot No. 22
Site Plan Name: Block No. 1 '�7
Project Name: l�l`Gt,VXe VJ c,(V_er
Setbacks Front Back: Right Side: Left Side:
DETAILED, DESCRIPTION OF WORK:
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I� 42, IR®
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CONSTRUCTION INFORMATION:
Additional Xdditional work to a er orme under this permit-check a apply:
�HVAC- Ei Gas Tank Gas Piping _Shutters Q Windows/Doors
Electric ❑ Plumbing Sprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
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Cost of Construction:$ (�QQ- Utilities: _Sewer Septic Building Height:
OWNER/ ES_ EE: CONTRA' TOR•
_ r ;
Name' .Name
Addre7- Company: OI+n.. Gi bs Cons truc`h o n fir-
City: '�T� ��`Cr State:i.FL._....._.Address:..- ... 4101:..0.
Zip Code: Fax: City: f:�F-41)1Iar-c-e. State:Phone No. 77� �'16- �7`/S_ Zip Code: 3 Yf f Z Fax: '772- Y&&-L y4/
E-Mail:_ Gf!Ikvn2 Wal(Cv q 1.2 ) �ya,llc v,,com_ Phone No. 712 F-e2 433Y
Fill in fee simple Title Holder on next page(if different E-Mail: `) m,) G-co bs w7o I 0 jj #v,&t 4 ro rV1
from the Owner.listed above) State or County License:
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
I
SUPPLEMENTAL CONSTRUCT! 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:
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.hol der 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 concur rency 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.
i
Signature of wner/Less /Contractor as Agent for Owner Signatur=D11%
ctor/ ense Holder
U
STATE OF ORIDA STATE
COUNTY OF 51-, Luc f"t COUNTY
The for oing instrument was acknowledged before me The forg ing instrument was acknowledged before me
this b day of CYO(9M , 201*7 by this day of �� C�AL'rL 20/�l by
lelvh �GD1.y J U �i►. �G oa�i�7
Name of perso aking statement Name of pe making statement
Personally Known/ rsoOR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
(Signature of Notary Public-State ure of Notary Public-State of Florida
P PATRI'CIA BTU ^ P PATRfCIA BTEVEt��-
Commission No.(o f<j [7 23715� �' ( �ZMY COMMISSION#G ! ssion No. (OG oz3 := QQ,'II11�
' EXPIRES September 9,2020 y _- MY d�RAl5510N#GG02++'
,,�;l EXPIRES September 19,2021.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION. SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW' REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED.
Rev. 8/2/17