HomeMy WebLinkAboutBuilding Permit Application i
ALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED q
Date: oLG �� Permit Number: 11 d 1J o, 1 I J
I ILL
RECEIVED SEP 2 6
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 ofi line
PROPOSED IMPROV MENT LOCATION:
�J Address:
-1�/I� nL` (�I L
Legal Description: �`� ��, 3(��C�G
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Property Tax ID#: - J - �c�v Lot No.
Site Plan Name: Block No.
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Project Name: ► ",' e- DIIU
Setbacks Frontl� !! Back: Right Side: —Left Sider
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DETAILED DESCRIPTION OF WORK:
_t*_ ,q Clcblu
CONSTRUCTION.INFORMATION CEOp
Additional work to e performed under this permit-c ec a app y: i
11HVAC E]Gas Tank Gas Piping _Shutters Windows Doors may`
❑ g a
F]Electric 0 Plumbing Fi Sprinklers E Generator R I of Roof pitch
Total Sq.Ft of Construction: S . Ft.of First Floor:
Cost of Construction:$ -7 CP Utilities: Sewer 0Septic Building Height:
OWNER/LESSEE:" CONTRACT( :L...
Name -I- z ( I
Name: I 0 0
Address:® D a ' cn t2ej Com a i4e7 A1t.t r'YI rVl i,t_i'/1,,i 1. I VrbPuS ���.
City: State:[--L Addr`ess: 1SA C� �('1 P1
Zip Code: Fax: City:, // JD �"� J-1 State:�-
Phone No.'-?-7- -. ���- �3�1 Zip Code: 5 1=i ax:
E-Mail: Phone No.-3)-(
Fill in fee simple Title Holder on next page(if different E-Mail:Ccki-(-i 1'ec4- t,� . 'Coon
from the Owner listed above) State or County License:OnC S
If value of construction is$2500 or more,a RECORDED Notice of Commencement is required.
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SUPPLEMENTAL CONSTRUCTION LIEN LAW INFORMATION.
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DESIGNER/ENGINEER: _Not p liq le MORTGAGE COMPANY: I_Not Applicable
Name 1 l Name:
Address: Address:
City: State: City: I State:
Zip:ba Ct hone I — to 4—t Zip: Phone:
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FEE SIMPLE TITLE HOLDER: _Not Applicable BONDING COMPANY: I_Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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OWNER/CONTRACTOR AFFIDVIT:Application is hereby made to obtain a permit to do the workland installation as indicated.
I certify that no work or installation has commenced prior to the issuance of a permit. 11
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, consult with lender or an attorney before
commencing work or recording our Notice of Commencement.
Signature o er essee/Contractor as Agent for Owner S gnAure of Cbnttact iWILicense Hof I der
STATE OF FL!1!!L)
STATE OF FL . IDACOUNTY OF CI C__ �O�L i�1 1 y/ COUNTY OF ! I
The forgoing instr4ment was acl nowledged before me The forgoing instr en was a knowledge efore me
this day of r 20 by this day of Oby
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Name of per making statement Name of per making statement
Personally Known OR Produced Identification Personally Known OR Produced Identification
Type of Identification Type of Identification
Produced Produced
Si nat "������ li -Sta V J NKINS
( g bQ�11��5 (Signat a of Nota P e �f�lo
r �s Notaryubllc-State of Florida �o ary ubllc-State o}Florida
Commission # 527 •� I Comml: GG 002527
Commission Commission Commission No. _ °� �
Expires Jun 14 202o y Comm. xp re Jun 14,2020
Bonded through National Nolm y Ass- /a1dld tfaoepA National Notary Assn
REVIEWS FRONT ZONING SUPERVISOR PLANS VEGETATION SEAITURTLE MANGROVE
COUNTER REVIEW REVIEW REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev.8/2/17
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