HomeMy WebLinkAboutBuilding Permit Application AllIAPPLICABLE INFO MUST BE COMPLET FOR APPLICATION TO BE ACCEPTED
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Date:T Permit Number:
RECEIVED SEP H a'2017
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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:�� �k 5C �411 VIA
PRQPQSED 11, EMEN T;LOCATLCN '..
Address: _ -
Legal Description: �ie!'Y) J-16
Property Tax ID#: z-- so?,?-D CO3 DODoZ - 600 J Lot No. 2
Site Plan Name: Block No.
Project Name:
setbacks Front 96�i Back:&Vp 7c;? Right Side: Left Side:
DETAILED DESCRIPTION OF WQRK. ".
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r�i ► A211f X 1C2.�' r��ers ., mod�5>Lee/ tQals 31 1103,ekAf
CONSTRUCTION lNFORMAT)ON
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Additional work to be per orme _ un er t is permit check all that app y
_Mechanical _Gas Tank _Gas Piping _Shutters _Windows/Doors
_Electric _Plumbing _Sprinklers _Generator _Roof Pitch
Total Sq. Ft of Construction: `12- Sq. Ft. of First Floor;
Cost of Construction:$ C100.O® Utilities: _Sewer _Septic Building Height:
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bw ER/LESSEE t CONTRACTOR;
Name d �e/ elY—er Name N1 ",
Address: ' i Company:
'City: pyhC State._ Address:
Zip Code: 349s1 Fax: 1l01'#(pS,)9 City:.';,a:.....:.. .. .:f:-::r=:__.,;...... State:
Phone No. / T02 — ;20 `70 qd— Zip Code: Fax:
E-Mail` l �/Y1i7 l Qef f 1 (Y1)M Phone No
Fill in fee simple Title Holder on next page(if different E-Mail
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from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CQNSTRUCTi4N LIEN.LAIN INF(3RRIIATIt)N`
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DESIGNER/ENGINEE Not Applicable MORTGAGE OMP NY: _Not Applicable
Name: GUR�i'" / �/� Name: coy) �E O�
Addres 37 m e A2d Address: 77 0
City: i'ier . State: City: c State:
Zip: 34%U Phone Zip: Ofi'loa8 hone: f 77 4o70—�5�(0
FEE SIMPLE TITLE HOLDER: _Not A plicable BONDING COMPANY: Not Applicable
Name: t— 6' _ l"" Name:
Address e kfd Address:
City: ierce City:
Zip: 3#955/ 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 A nt for Owner Signature of C ntractor/License Holder
STATE OF FLORIDA / v 'STATE OF FLORIDA
COUNTY OF COUNTY OF
The forgoing instr ent was acknowledged before me The forgoing instrument was acknowledged before me
this day of 20 / y this day of 20_ by
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(Name of erson acknowledging) (Name of person acknowledging)
ignature of Notary Public-State of Florida ) (Signature of Notary Public-State of Florida )
Personally Known V OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced ced
MARIA MATILDE ESQUIVL
V'27 ;�) Notary Public-state of FI ridgy
Commission No. V a CommissionifGG1012)71.o ission No. (Seal)
>44 cZe§'/ My Comm,Expires May 3, 021
- -."oFc�••' Bonded through National Notary issn.
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
.DATE
COMPLETED
Rev. 7/2014