HomeMy WebLinkAboutBuilding Permit Application ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: �` 1 l Permit Number:
RECEMH SEP 2 2 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 `
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED-IMP'ROVEMENT LOCATION: ' � '' �
Address:
Legal Description: 4
Property Tax ID#: .�� — `�1 5 r (7C`�C�o?-- ® -- Lot No.
Site Plan Name: Block No.
Project Name: -33 00 14 V e
Setbacks Front Back: Right Side: Left Side:
DETAILED DESCRIPTION OF.WORK
` - rood
;
R'i4
CONSTRUCTION INFORMATION t ` r, ;�:
Additional work to be nerformed under this permit—c ec all that apply:
i
E]HVAC _Gas Tank ❑Gas Piping _Shutters ElWindows/Doors
Electric 0 Plumbing Sprinklers O Generator W�oof F97-Ti Roof pitch
Total Sq. Ft of Construction: I �J7� S . Ft.of First Floor:
Cost of Construction:$ n®(� Utilities: Sewer E]Septic Building Height:
i
OWNER/LESSEE CONTRACTOR ?
Name'Erne!4 A011`1Pry-,-5 Name: y1�,
Address: 5 f205 AVe. Company: cjie�C/ ,(,t A �!/?1.u7
City: Fl�i ecr« State: Address:
Zip Code: 3�( ,fiq Fax: City:fig� State: VJ
Phone No. `? 'S g— Le I Zip Code: Fax:
E-Mail: i II 139i3 @, f1G Phone No. ir 5(o1'7_z/981S, / 37139 if
Fill in fee simple Title Holder on next page(if different E-MaiMa4 ccf 1iY1
from the Owner listed above) State or County License: Co 1C !V9q_j
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
i
i
'SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION: ;F4
DESIGNER/ENGINEER:�� _Not Applicable MORTGAGE COMPANY: _Not Applicable
Name: /� i—� Name:
Address: Address:
City: State: City: State:
Zip: Phone: Zip: Phone:
FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: _Not Applicable
Name: 062 14 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 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, con with lender or an attorney before
commen ' ork or recordin&your Notice of Commencemeyit.
s
Signature o Owner essee/Contractor as Agent for Owner Signatu e ntractor/License Holder
STATE OF FLORIDA STATE OF FLORIDA
COUNTY OF 5l/-WC f COUNTY OF S� aLU t,�\`Q '
The forgoing instrument was acknowledged before me The forgoing instrument was acknowledged before me
this, day of Se P 20 (7by this day of Se D .20 n by
®� I t/— C6 I
(Name of person ledging) (Name ot person acknowledging)
(Signatur f Notary li a of Florida ) (Signature of Notary P lic-State of Florida)
i
Personally Known_5!!�n O Produced Identifi atio Personally Known OR Produced Identification
Type of Identification Produced Type of Identification Produced T10L.
I
Commission No. (9C��RAE000R71EY Commission No.Rubes Am is-2M
�6 �0 (Seal)
* * Commis6ion f(�i f1S�
'X
Fof�� Dard.d7ln+Bu�tNdr�Sw� '
Revised 07/15/2014
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
I
COMPLETE '
INITIALS
i
i