HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED 7,�,,
Date: W 1 I Permit Number: ' / �.' `�'�L
ECEIVED
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' APR 18 2017
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 ;<
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PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPED I(VII?R01/EM�NTtLOGATION
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Address: (. , ve.nu b7 Off- 3
Legal Description:
Property Tax ID#: _ DOD Lot No.
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Site Plan Name:
Block No.
Project Name: V- 61S S
Setbacks FrontI577'l��-1-7 Back: '� Right Side: I ' Left Side:
DETAILED DE5CRIPT IONOF
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CONSTRl1CT1C7�N`INFORMATiON
rtiona,work
.to e e orme under this permit—check' a apply:
11HVAC EI Gas Tank ❑Gas Piping In—Shutters Q Windows/Doors
Electric Plumbing Sprinklers Generator ��R_.I of
Total Sq. Ft of Construction: S . Ft.of First Floor: �J
Cost of Construction: $ f`'�y` Utilities: _Sewer®Septic Building Height:
01NNER/LESSEE ' �: t ON ACTOR ; � �A
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Name �� Nam in � 1
Address: ltl ,Company:: f GrCY'. (e avg
State:► Address i 0.
Zip Code: `�,'° . -Fa City: �1 � �,; Stater
Phone No. �a1—319" Zip Code: 17H(l5 t Fax:
E-Mail: �` Phone No.119-3"10--1089 I✓
Fill in fee simple Title Holder on next page(if different E-Mail: V—Ao iL)! KY1G1r'A`e�1L1( S�
from the Owner listed above) State or County License: ' I CO k d�5-7 C�
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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�$U,PPLEM$EfVTAL CON{STRU'CTION LIE,N,,LAW INFOR�NfATION yf����,�k�°, , �f � ' �'r, r �'', �` r -�r�
DESIGNER/ENGINEER: _Not Applicable MORTGAGE COMPANY: Not A licable
Name: — pp
1 ij,�yy) Py��F�� Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
I certify that no work or installation has commenced prior to the issuance of a permit.
St. Lucie Countyy makes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in contiict 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/Agent/Lessee Signature of Contractor/License Holder
STATE OF FLORIDA j , , STATE OF FLORIDA4��r� I r Y �
COUNTY OF - iA��L COUNTY OF i
The fo66going instrurrxnt was acknowledged before me The f going instru n was acknowledged before me
this 1 day of >�a 20�by this day of 71 20A by
_�Z)Onw\A MOI&C-4....'
(Name of person acknowledging) (Name of ppZson acknowledging)
Ilk
(S gn ure of P Notary ubl' State of Florida) ature of Notary Public-State of Florida)
Personally Known `�/ OR Produced Identification Uscrially Known ! OR Produced Identification
Type of Identification Produced pe of Identification Produced
Commission No. 5d balyd suteotF�orwa mmission No.0 l( k, (c�Public SweofFlo "
my Commission �l; Julio Belyd
' MY CommK�lon FF 163206
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW RE IEW REVIEW REVIEW.. REVIEW REVIEW
DATE
COMPLETE I ,i
INITIALS