HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: ��`&3��1 Permit Number:
RECEl% r0 OCT 2,3 2017
J�q
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 JC
PERMIT APPLICATION FOR:
PROPOSED IN.,RR®VEMENT L®CATfON:
Address: SaD� 1�l}Jc--rgac'D121V-6� _f-D�'(I�IF.J-2C-E,
Legal Description: �L IAIf 121V
(MAf 38-78—b5o�
Property Tax ID#: � � — 6Do'i — e�)i i L�-- 000—I Lot No.
Site Plan Name: — Block No.
Project Name:
Setbacks Front C , Back: Right Side: Left Side:
DETAILED D�E�SCR+IPT!®N ®F 1NORK:
CONSTRUCTI®N INFORMATION:
- Additional work to be pertormed under this permit—check all that apply:
_Mechanical _Gas Tank _Gas Piping _Shutters X Windows/Doors
X Electric _Plumbing _Sprinklers _Generator X Roof 9/j2 Pitch
Total Sq. Ft of Construction: I Ay o Sq. Ft. of First Floor:
Cost of Construction:$ aJ', C>9• UZ2 Utilities: _Sewer _Septic Building Height:
OWNER/ 1CQNTMC:TJOR:
Name Name: DW �2
Address: �a'(C�.� 1D!I.f�'� Ef211l Company:
City: -F-D" iq1tRc�c_ State:F1— Address:
Zip Code: 3q-98y Fax: — City: State:
Phone No. (i-7a) Zip Code: Fax:
E-Mail: Phone No
Fill in fee simple Title Holder,on next page(if different E-Mail
from the Owner listed above) State or County License
kLu-•- 6 k-pI "o-hoo,ciny-)
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
rSUPPLEMENTA�CONSTRUCTIQN 01i LAUV INF®RMA►TION:
DESIGNER/ENGINEER: Not Applicable MORTGAGE COMPANY: Not Applicable
Name: .5C IT R, 5tA I-rDE126 P,F. Name: C mwl M__9 �5A WY,
Address: 5911 PE5CA A VP-lv& Address: bOD 0VWg6?jD5
City: T nCE State: 7R_ City: CW-f PIflzo& State:
Zip: 171 Phone ("Tab-3- 36 Zip: �5"89-- Phone:
FEE SIMPLE TITLE HOLDER: X Not Applicable BONDING COMPANY: X 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.
�o f k "a' Q
Signature of OwncW Le ee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 1_•U C.%t COUNTY OF
The forgoing instrument was acknowledg; before me The forgoing instrument was ackno ledged before me
thisQ•3 day of Q&A 20�! by this day of 20_ by
(Name of person acknowledging) (Name of person acknow edging)
(Signature of Notar ublic-State of Florida) (Signature of No ry Public-State of Florida)
Personally Known OR Produced Identification Personally K own OR Produced Identification
Type of Identification of Id tification
Produced b— ���=��—= `p` 1NAr�1.4RIEGNEN Pro cep
-20 pnY COMMISSION#GG 02 02
Commission No. :�s$�� ealkx?l ES:De"mbe"642 20 ission No. (Seal)
'((' '•• Thm Notary Public Und ro
I
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE 1 �
RECEIVED 1
DATE
COMPLETED
ev.