HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETL& RJR APPLICATION TO BE ACCEPTED
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Date: to ° Permit Number: r / V 6_ a �2J_
ED
�- _... M ....:. Building Permit Applic '
Planning and Development Services -. � JUN / 8 2017 11
Building and Code Regulation Division
2300 Virginia Avenue, Fort Pierce FL 34982
Phone: (772) 462-1553 Fax: (772) 462-1578 Commercial R ', ential
PERMIT APPLICATION FOR: � �-G'� �hl✓ 401�_ ,- Gam►'' ,—�—
PROP®SE f f�NPROUEMENT L�CATI®N:
Address:��/12��
-- nn�(ZI.
Legal Description: A' --``-CAA
Property Tax ID #: ®= 342A (Qoq w6 4- o00019 Lot No.
Site Plan Name: Block No.
Project Name: ® I1``D14 4 21)tM i�_S- 646S
Setbacks Front Back: Right Side: Left Side:
DETAILED DE�SCRIPTIO'N ®F' 0
/
11COMN-SITIRUCT 0'N fNFORMATION:
Additional work to be pertormed under this permit- check all tat apply:
Gas Tank Gas Piping _ Shutters Windows/Doors
_Mechanical _ _
Electric Plumbing _ Sprinklers = Generator ifilikof Pitch
_ _
Total Sq. Ft of Construction: wgi s I 1pl� Sq. Ft. of First Floor:
Cost of Construction: $ (300 . 0 O Utilities: _ Sewer _ Septic Building Height:
OW E /LE�S�SE:
CONTRALTORN
Name I Lk C'J '
Name:
Address: W! t C �►
Company:
City: State:L
Address:
Zip Code: Fax:
City: State:
a' 0 L4P
Phone No4simpole
Zip Code: Fax:
E-Mail•O S O C-C)M
Phone No
Fill in feee Holder on next page ( if different
E-Mail
from the Owner listed above)
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: Not Applicable
Name: t7 i <D
Address c (� t[tY�'
T State: V
O,�' = Phone"
FEEtIMP,LE�TITLE HOLDER: '"r Not Applicable
Name:
Address:. ,
Zip: -..Phone: - .' ._"
MORTGAGE COMPANY:
Name:
Address:
Citv:
Zip: Phone;
Not Applicable
State:
BONDING COMPANY: _Not Applicable
Name:_
Address:
City:_
Zip:
Phone:
OWNER/ CONTRACTOR AFFIDVIT:-Application is hereby made tolobtain 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 lender or an attorney, before
�.,Iv..v,nnrina %einrlr nr rarnMino vnur Nntirp of Commencement.
Signature of Owner/ ess a/Contractor as Agen
or wrWr r
Signature of Contractor/License Holder
r To
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF
M 5 2
�_
COUNTY OF
io
The foin.g inst ent was acknowledged before Qy lw
Oa: 1E
The forgoing instrument was acknowledged before me
day 20_ by
thisdy of 20�tZ by
¢ >-w
this of ,
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o.
(Nan -(a of person acknowledging)
(Name of person acknowledging )
(Signature of Notary P blic- State of F orida)
(Signature of Notary Public- State of Florida )
l
Personally Known �OR Produced Identification
Personally Known OR Produced Identification
Type of identification '4!_
Type of Identification
,, tt n
Produced P w(o �"I O 610 " T (0 V
Produced
Commission No. (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEATURTLE
MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
RECEIVED
DATE
COMPLETED
Rev. 7/2014