HomeMy WebLinkAboutBuilding Permit Application All APPLICABLE INFO MUST BE COMPLE3'R FOR APPLICATION TO BE ACCEPTED
Date: ' �3 �� Permit.Number: �
APR 13 2017
10 Building Permit Application P�F;::41TTI16G
Planning and Development Services St. Lucie County, FL
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: M��� bu•
21 RKI R P®S�'D2INPR01/EMENT Lr®CATIO
Address:
Legal Description:
Property Tax ID#: !f 3 01 y J fD 7- 0 00- I Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back: Right Side: Left Side:
D LED D aSC + P 10'N OF WORK.:
1 30! fVl, l '25-6-A [ - of 66b
C®NS RUCTION 181 M TI,O'N:
Additional work to be pertormed under this permit—check all that app y:
_Mechanical _Gas Tank _Gas Piping —Shutters i. Windows/Doors
_Electric _Plumbing _Sprinklers _Generator —Roof Pitch
Total Sq. Ft of Construction: , Sq Sq. Ft.of First Floor:
Cost of Construction:$ 2 J . Utilities: —Sewer .'—Septic Building Height:
OW f�R/LESS !E: CONT AC OR:
Name -JrD1,.ar1 Name:
Address: a,30� ��nn� v� -Company: - - =-
City: c Y e.rC2 State:( - Address:
Zip Code: :3 f44)1-1 Fax: City: State:
Phone No. l2 ��`1 —DI S Zip Code: Fax:'
E-Mail: vfzs Phone No
Fill in fee simple Title Holder on next page (if different E=Mail
from the Owner listed above) State or County License
If value of construction is 2500 or more,a RECORDED Notice of Commencement is required.
SU!PRLEM w TAL MTRIItvT10N LfEN LAW INF®RMATL®N:
DESIGNER/ENGINE R: Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: `71Am-S Xr-Ab t Name:
Address: COGS Ii. U" yark uenjj•e__ Address:
City: I State: f- City: State:
Zip: 1a7110 Phone 38 - 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 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 insp =rding
If you intend to obtain financing, consult with lender or an attorney before
commencin work oour Notice of Commencement.
Signatu a of Owner/Lessee/Contractor as nVn _ ure of Contractor/License Holder
STATE OF FLORIDA E OF FLORIDA
COUNTY OF - �GUC�� COUNTY'OF
The forgoing instryment yv s acknowledged before me The forgoing instrument was acknowledged before me
this day of I 20_ by this day of 20_ by
0--1,&qR0
Name of berWn acknowledging) (Name of person acknowledging)
c¢—�
(Signature of Notary Public-State of Florida) (Signature of Notary Public-State of Florida)
Personally Known OR Prod ,J neronally Known OR Produced Identification
Type of Identification °`aa� KAREN S. NIE Identification
" ' Commission# FF i d
Produced .° My commission E June 12, 20Commission No. o sion No. (Seal)
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
ev.