HomeMy WebLinkAboutBuilding Permit Application i
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED j
Date: Permit Number: '
y _ RECEIVED SEP 2 5 2017
Building Permit Application
Planning and D velopmentServices
Building and Co l e Regulation Division
2300 Virginia At enue,Fort Pierce FL 349821
Phone: (772) 62-1553 Fax: (772)46271578 Commercial Residential
PERMIT APP ICATION FOR: To Select from dropbox, click arrow at the end of line r00 f
PROPOSEDtf PROI�EMIENT LOCATIII`" , ' ,; �'k �" l
Address: -Z a 5 V
Legal Description: l ayai a`&
Property Tax ID it: Lot No.
Site Plan Name: -- y.-p 14 getag Block No.
Project Name:
Setbacks Front 'Back: 1 Right Side: Left Side:
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Additionalwork to be performed under t ispermit-check all that apply: .,
E1HVAC Gas Tank - ❑Gas Piping _Shutters Q Windows/Doors,
Electric 0 Plumbing `Sprinklers 0 Generator Roof
p- L'Total Sq. Ft of Cc nstruction: p �J i ,. S . Ft. of First Floor:
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Cost of Construction:$ �+ �� . Utilities: _Sewer Septic Building Height:
OIIVNEf%L'ESE iC01UT�i ► 1"OR• � � i
Name. Name: 1 a F
Addy ss f _L 4 Company: L
City:. r ! State. Address:
Zip Code: Fax: City: State:
Phone No. Zip Code: 3gL?q-7 Fax: -7-7a 7763
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E-Mail: Phone No.
Fill in fee simple Title Holder on next page(if different E-Mail: i/,Qd�CJCl y5 , �jSLl2
from the Owner listed above) State or County ' ense: L&
If value of constru tion is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMEN AL CONSTRUCTION LIEN LA1N`INORMATION k : R
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DESIGNER/EN INEER: _Not Applicable MORTGAGE COMPANY: Not Applicable
Name: 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 vkrk or installation has commenced prior to the issuance of a permit.
St. Lucie Count yy akes no representation that is granting a permit will authorize the permit holder to build the subject structure
which is in conflic with any applicable Home'Owners Association rules, bylaws or and covenants that may restrict or prohibit such
structure. Please onsult 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 buil ing 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 TOOWNER: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
commencjAg work or recording our Notice of Commencement.
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_Sign ture ner/Lessee/Agent Signature of Contr for/License Holder
STATE OF FLO ID STATE OF I LORIDA
COUNTY OF COUNTY OF�1 `r'1
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The for oing instrument was ack owledged before me The for^_going instrument was acknowledged before me
this day of O�Y1 � 20 I-7 by thiso�J day of �(nj'o 01_ 20 by
e a Lq ICL5 F
Na e f personacknowledging) (Name rson acknowledging)
(Signatu)of Not ry Public-State of l n a) (Signature)f Notary Public-State of I ri a)
Personally Known OR Produced Identification Personally Known OR Produ I _ratification
Type of Identification Produced— //t' (7 L Type of Identification Produced
Commission No. �`°' P REBECCA RESTIF
O (Seal) Commission No. a� *Etaf)COMMISSION 9 GG9186
Y PU RESTIFO EXPIRES:May 17,2021
ISSION#G
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May 17,2021
OF
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
COMPLETE j
INITIALS