HomeMy WebLinkAboutBuilding Permit Application I
ALL APP CABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: a�. Permit Number: ' ® U
RECEIVED
•_..., Building Permit Application SEP 2 7 2017
Planning and Development Services
Building and Code Regulation Division PERMITTING
2300 Virginia Avenue,Fort Pierce FL 34982 St. Lucie County, FL
Phone:(772)462-1553 Fax:(772)462-1578 Commercial Residential _
PERMIT APPLICATION FOR: To Select from dropbox, click arrow, at the end of line
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Address-
Legal Description:JAQCt h y <W 2 [ fiD(1Ltt°. J2id4C p�Glf CE-CA h1-f' "� J�
yYhc-' hit" /ram,
Property Tax ID#: u1
__ LJ 00 ' 03 ^Cf! 0 - vu Lot No.
Site Plan Name: Block No.
Project Name: �h cy f1-e-S
Setbacks Front Back: Right-Side: Left Side:
P s.
`t�eplace� 5• ter, sp��rt �(L wI ��� ao .�
+t ,, <pti`. '4 t • er ,�, .. .r� �ti..r- r«eft. _A'. �f :a' ;.
AddAonalwor to e e orme un ert is perm it-c ec a appy:
HVAC Gas Tank ❑Gas Piping _Shutters Q Windows/Doors
_Electric Plumbing Sprinklers -Generator EI Roof Roof pitch
Total Sq.Ft of Construction: /� S . Ft.of First Floor:
Cost of Construction:$_ ( , u q Utilities:lSewer Septic Building Height:.
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v Ord;
Name Name: e
Addre�ss;,:�` f �II(a tl i nee— C`i' Company: f
City:km uf:- J State: L Address: R,
Zip Code: - 4 i7 Fax: City: rr''tASt�a7te:�`�
Phone No.—J"Ja �4 ) �� Zip Code: Fax: J`T-- t�r} �J1(3-
E-Mail Phone No. - -
Fill in fee simple Title Holder on next page(if'different E-Mail: et
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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DIgGN63HNGINEER `Not Applicable MORTGAGEOOMPAM( Not Applicable
Name: Name:
Address:
.Address:
Oty: gate: aty: gate:
Zip: Rhone ZIP: Phone:
FEEWFLE-nTLEHOLD82 _Not Applicable BONDINGOOMPAM! Not.Applicable
Name: Name:
Address Address:
i aty: qty:
ZIP: Rtone: Zp: Phone:
OWNER ODNTPAC;TCRAFFI MAT Application l0ereby made to obtain.a permit to do the work and installationas indicated.
Lcertify that no work or installation'hascommenced,prior to the issuance of a permit:
3.Lucietbunt ,makes no re rze�rr��tationthatj ranting apermit will authorize the nit holder to build the subVc t structure
which is�n conflict wrthan applicable 1-bri�e pwrf�rs ssoaation rules,b lawsor an :covenantsthet may restrict r rohibit such
structure:Rease oonsult Mr
your Home canmerssoaation and rewewyyour deed or any restnctionswhich may apply.
In eorisideration 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,theAorida:Building ODdes and g.Lucie OauntyAmeridmerits
The following building permit applications are exempt,from undergoing aftill conwrrencyreview.room additions,.
accessory structures,swimming pools,fences walls`,signs,screen roomsand accessoryusesto another non-residential.use
WARMNGTO OMER Your failure to Peeord a Notice of tbmmenoement.may result.in your-paying twice for
improvements to your property.A Notice of Cemmeneerviei t must,be recorded and posted on the jobsite
before t first inspection. If you intend,to obtain financing,consult with lender or an attorney before
aom n work or recorclinn vnir Notioe of Cbmmencement.
atur , f.Ovine Oontractor as t for Owner Sgnattkje of Cqr#ador/Owhsa,Holder
STATE OFRJD SfATEOFR GRID, p
COUNTY OF - ODUNTY OF
The f cgoing instru ent was owledg efor .# ro The forigning instrument-was aplmovviedgwbefore me
th day 20 by . ttiisday of 20 by w
Coat 1Z O N y
O ;W ` H .�-
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Name of p J��paklngstatement o E Name of p n making statement _ .n
Personally Known ORF7oduced Id tiff a FersonallyKnown ORRroduced Identificati i z�
Type;of Identificati ._ 45 Type.of,ldentification 4 g
Produced .2 Produced
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11 CL Quern
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(Sgnature of Not//11 I . 3ate of Rorida ' (9gnature of Notary Public- a of Rorida)
fbmmisson No. "t' ( ( �) •°r`;;�.,.,• Ebmmission No.
1 F�EI/IENS ZD FNG
a)PER SOR RA , vEfumoN ;FATuRTLE MANGROVECC NTER REVI FSAEW MA SA REVIEW REVIEN' FBABN
DATE
F�HV137 ..
DATE I
OOMPLEI'E-D Ii'. I. ���•
Rev.8/2117
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