HomeMy WebLinkAboutBuilding Permit ApplicationAM- PMABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED bq
Date: �'' -' yUj 7 Permit Number:
Building. Permit Application
JUL 3 1 2017
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:
Address: of (0
Legal Description:
►J
Property Tax ID #: — c) 0 7' 9- — 0 (2 Lot No.
Site Plan Name: JJ Block No.
Project Name: c4-n 1 )1 d %' It k-'
Setbacks Front Back: Right Side: Left Side:
Aciciitionai worK to oe pertormea unaer tnis permit- cnecK aii tnat apply:
_Mechanical _ Gas Tank _ Gas Piping _ Shutters _ Windows/Doors
_ Electric _ Plumbing _ Sprinklers _ Generator t.�oof Pitch
Total Sq. Ft of Construction: Sq. Ft. of First Floor: /Z" h d
Cost of Construction: �Z :r 7 S -'� Utilities: —Sewer —Septic Building Height:
O1NN'ERrLE�S�SE
GONT'RA � OR:
Name�,�'/j✓�w G�/��' -
Name: x
Address:/ bvi 4 0"
Company: �G A_4'
Address: }-U w/C/ i
City: "C State: /
4
Zip Code: 3115 y) Fax:
Phone No. 7 7a -
City: State/
Zip Code: Fax:
Phone No - 0) d'"
E-Mail:
Fill in fee simple Title Holder on next page ( if different
from the Owner listed above)
E-Mail
State or County License C C C II.A-0, 7 Zfs
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
-uPRrCMRur�. C(JNSTRIUTIC•}N LIEN uvu NoRMAT�or
DESIGNER/ENGINEER: _ 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:
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 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 Ie_P4eT--a71an attorney before
commencing work/ur-wcording vour Notice of Commencement. .11�
Sign ap6r&.dfWw-Vr/ Lessee/Contractor as Agent for
e Holder
STATE OIFFLORIDA7,, m STATEOF FLORIDA J le
""COUN OF Q ' a- X{a COU OFThe fpr oing instFei ent was acknowledged before CO -< The fo9oing instr nt was acknowledged bCthis day of�, 20 /7 by wz=thisday of 20�
(Name of persoh acknowledging )
l
(Signature of Notaryli bc- State of Florida )
Personally Known OR Produced Identification
Type of Identification
Produced
Commission No.
(Seal)
(Signature of No a Public- State of Florida )
Personally Known �OR Produced Identification
Type of Identification
Produced
Commission No.
(Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
3
RECEIVED
DATE
COMPLETED
Rev. 7/2014