HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number: Dal!-
RECEIVLzD
Building Permit Application
Planning and Development Services NOV 13 2017
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
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Address: -Part P9—' 3-49902-
Legal Description:
Property Tax ID #: UN- Cox -0003 Lot No. 4�1
Site Plan Name: Block No.
Project Name: _ D rs )i it %h -
Setbacks Front Back: Right Side: Left Side:
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Additional work to be Dertormed under this permit - checK all apply:
[1HVAC 11 Gas Tank []Gas Piping Shutters E]Windows/Doors
0 Electric El Plumbing OSprinklers Generator Roof Roof pitch
Total Sq. Ft of Construction: S Ft of First Floor:
Cost of Construction: $ I_rAO. e),b 4,c-, b Utilities:'n Sewer ,erg- Septic Building Height:
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Name L)20161 14 Mki �_'r Name
Address: S(val d_e__1Ai17e11 Y � Company:�C1:>e1-r(-c'r_T0g_
City: State: � Address: t
Zip Code: .3441?B2 — Fax:-77gl TEO q1731 City: State: f-_/_
Phone No. 7 7,2 ?Tg 5/12411 Zip Code: _ 3 4-1 17 7 Fax:
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Fill in fee simple Title Holder on next page ( if different E-Mail:
from the Owner listed above) State 70 unty License:
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If value of construction is $2500 or more, a RECORDED Notice of Commencement is required.
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DESIGNER/ENGINEER: Not Annlicable
MORTGAGE COMPANY: Not Applicable
Name: Rpa�ry KOS i - I - N
Name:
Address:
Address: 94o 1&'C./Se- 671
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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:
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
that or such
which is in conflict with any applicable Home Owners Association rules, bylaws or and covenants may restrict prohibit
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 your Notice of Commencement.
Signature of Owner/ Lessee/Contractor as Agent for Owner
Signa re FCbktractor/License Holder
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Personally Known OR Produced Identification
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M OMM ISSION # FF909628
My COMMISSION 9 FF
'C_:. n. o. EXPIRES August %,2019(Se 1)
co EXPIRES Augog Ia. 2019
(407t39S:0153 F10r1d,1NrAafySemre.coru
(4071 398-OIS3
REVIEWS FRONT ZONING SUPERVISOR
PLANS VEGETATION SEA TURTLE MANGROVE
COUNTER REVIEW REVIEW
REVIEW REVIEW REVIEW REVIEW
DATE
RECEIVED
DATE
-COMPLETED
Rev. 8/2/17