HomeMy WebLinkAboutBuilding Permit Application (2) All APPLICABLE INFO MUST BE COMPLETE FOR APPLICATION TO BE ACCEPTEa'
Date: o�� I� Permit Number: 11 d<� 1 S3
RECEI1'`.D SEP 2 8 2017
J Olt
Bi ��ig�P� ri�$'i 'rkpplication
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
PERMITAPPLICATION FOR:
PROPOSED INPROVENIENT LOCATIQN:
Address:
LegalDescription: Civcl, Pe cF,1 - Un . 6 �, li -3Y Ili
�ioe -.zr-7,7- r-�-)
Property Tax ID#: \°\- 'S61- a0 uo\-Oa0-4 Lot No.
Site Plan Name: Block.No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
IDETAILED DE�SCRIPTI N OF WORK. .
4 �G',� Gl'GC !1J Goy— Cf Jy►Ci y<� GLI D 6 •r G�'V-Gf� � 1
CONSTRUCTION INFORMATION:
Additional 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
Ti tal Sq. Ft of Construction: Sq. Ft.of First Floor:
Cost of Construction: $_ ���� Utilities: —Sewer _Septic Building Height:
OWNER CONTRACTOR:
Name c.fG,pr Name: !',ii J' 0 u✓h.F+-.•
ddresss: �� wO 0/ 1C,'�J` (f �' Company: C �+ e� s Pk1J / li
(City: A.. d 1 14 Ar'h, kg44 State:F_L Address: �✓�d���� G
Zip Code:2,ly J Fax: City: State:
Phone No. Zip Code: -3 y Fa
E-Mail: Cc 0 `" Phone No
iFill in fee simple Title Holder on ne9page( if different E-Mail CGS 1'n �'t •��y'`
from the Owner listed above) State or County License G16
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
laid
MOWME EtVIEN FAL CONSI' UNION LI �N LAIN iiU'FOR+I lA1"Ia l
DESIGNER/ENGINES : Not Applicable MORTGAGE COMPANY: Not Applicable
Name: VSfC� GJ! " ,:1J b Name:
Address: 4/M, X/r acz,�F ✓ Address:
City: State: L City: State:.
Zip: Phone j "21 Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: XLNot 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 th first inspection. If you intend to obtain financing, cons It with lender or an attorney before
comry1ppgi,hg work or rpcqrding your Notice of Commence/m
Signature of Owner/Lessee/Contractor as Agent for Owner Signature of Contractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF S k . �yc�t COUNTY OF
The for oing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this day of S t2�- 2011 by this day of 20_ by
�n.a C-\N 4
Name of person making statement. Name of person making statement.
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced '�4 ID L Produced
(Signature of Nota u •tale Of�dAZMWEGIVENS (Signature of Notary Public-State of Florida)
+�r� MY COMMISSION#GG 022023
Commission No.1►�= EXPIRE ber16,202o Commission No. (Seal)
•:.FoFF�o;.` Bondedl"hru�otaryubllcUndenvriters
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEATURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev. 8/2/17