HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLE'rrV FOR APPLICATION TO BE ACCEPTED F ,
Date: �1- )1 + " i Permit Number: In-, • 0, l)l
Planning and Development Services
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578
WED
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Building Permit ApplicationL 2017
PERMITTING
St. Lucie County, FL
PERMIT APPLICATION FOR:
PROP SEED 6N110,TO fEME T LClCAT 6N:
Commercial Residential
Address 100 V n ct,G I♦r2 AtJ 1= f'r e 1� F / 3 Li ^ s l
Legal. Description:
Property Tax ID #: (3) -1O ) - CEO 31 ^ 0009 Lot No.
Site Plan Name: Block No.
Project Name:
Setbacks Front Back:
amonai worK to De perrormea unaer
"Mechanical Gas Tank
Electric _ Plumbing
Right Side: Left Side:
ermit — cneCK all tnat apply:
_ Gas -Piping _ Shutters
Sprinklers
Total Sq. Ft of Construction:
Cost of Construction: $
Name _fC,Ca Hock
Address: I R 'rA0ar11r1 wAj4
City: el pier t= f State:
Zip Code: 3H C1S / Fax:
Phone No. -11 Z- Llol - _3063
E-Mail:
'Windows/Doors
Generator Roof Pitch
Sq. Ft. of First Floor:
Utilities: —Sewer —Septic Building Height:
Fill in fee simple Title Holder on next page ( if different,
from the Owner_ listed above)
Name: C4ar�O Xr Snlu�ic,j
Company: 15 S, LAJ (s 4c z a L
Address: (y QZ C� !ac c L a
City: I 7 ;hi ,e✓ ce. F t State:_�- 1
Zip Code: 3 K J s I Fax: 7Y) 2- go (-S39T
Phone No -1-) W -1 c l
E-Mail Cae,
State or County License CSC 1 a f 506!
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
UPP MENTAL CONSTRUCTION LIEN LAW NFQRrMAfilrK
DESIGNER/ENGINEER:' _ Not Applicable
MORTGAGE COMPANY: _ Not Applicable
Name:
Name:
Address:
City: State:
Zip: Phone
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
BONDING COMPANY: Not Applicable
Name:
Name:
Address:
Address:
City:
Zip: Phone:
City:
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 irryour 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 .
rnmmanring XAinrk nr rarnrdinrr vnur Notice of Commencement.
SignatureLdf Contractor/Lic a 1461cler
Signatu f Owner/ Less(e)CGdtractor as Agent for Owner
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF 2AIVX
COUNTY OF''
0•
Th forgoing instrument was acknowledged before me
thi7 day of 20ja by
The forgoing instrument was acknowled ed befd're `me' '
this d! day of 20D- by
(Name of per on acknowledgin )
(Name oTpet%on acknowlMging(I) -
4y-
nature of Notary Pub i State of Florida )
Public- Florida)
YlgnaWre of Notary Nte of
Personally Known OR P=oduced_Identifi-ati.a
, er ally Known OR Produced Identification
��"""� LASHAHNA INGRA
Type of Identification .taRY PG,,
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Produced : _ ¢,� Notary Public -State of
:• « - x. °tl My Comm. Expires Dec'0,
Commission
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T e f Identificatto n
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FiArdd ed ,�` RY e,
2018 ?_ �u �'� Notary ub is tare of Fto�ira
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Commission No. eall # FF 17
�����" nded through National Not
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REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DA
W
p
lA
DATE
COMPLETED
Rev. 7/2014