HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: Permit Number:
RECEI`.'7.D JUN 12 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 _A Residential
PERMIT APPLICATION FOR: To Select from dropbox, click arrow at the end of line
PROPOSED IIVIPRdlyE "A •NT LOCATLQN
Address: -?SSb S . OCC tk-(-\ bC. :j P VItIO(\-b4ec,[�0 , R. 3-4 er 91
Legal Description: Z,Stcty\cA1',-4 Z " ttn +
2 U (e S' - ZEo I `t
Property Tax ID #: f+SO 2 (oQIO'i - 000 " Z Lot No�L64
Site Plan Name:
Project Name: - _l._S (CL,(1A 1 6
Setbacks Front Back: Right Side: Left Side:
Block No.
Haaitionai wori< to De ertormea unaer this permit- cneck an apply:
�HVAC Gas Tank Gas Piping _ Shutters Windows/Doors.
Electric ❑ Plumbing Sprinklers Generator _ Roof Roof pitch
Total Sq. Ft of Construction: S . Ft. of First Floor:
s
Cost of Construction: $ z 211 . Utilities: Sewer Septic Building Height:
UWNAER/LESSEE
CONTRACTOR
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Name &b, bil
Name:
Company: ! T
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Address: Q C I50S—
City: SQ. fh
State: EL
Address: vl
Zip Code: _3!q9$ q- Fax:
City: &{ a ftelT
State: 1:.-L_
Phone No. 1'7a - 0b"-6- 5(o13
Zip Code: _ 6-te(Ct !f Fax:17(a--
Phone No.
334 -101g
y
E-Mail: A-e -f -1 AC. q4Z,+
Fill in fee simple Title Holder on next page (
if different
E-Mail: (M16tiv-a
e_ 1
from the Owner listed above)
State o my License: 6 CC 13 I I
S 11 L�3
it value of construction is.52500 or more, a RECORDED Notice of Commencement is required.
DESIGNS
Name: _
Address:
City:
Zip:
Phone:
Not Applica
MORTGAGE COMPANY: _ Not'Applicable
Name:
Address:
State: City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable BONDING COMPANY: _Not Applicable
Name: Name:
Address: Address:
City: City:
Zip: Phone: Zip: Phone:
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 contlict 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 attornev hefnre
commencing work or
re of
STATt-AF4LO(DA�V `A,
COUNTY OF ��--
ur Notice of Commencement.
as Agent for Owner
The forgoing instrument was acknowledged before me
this lAs day of SJhk_ 20N]_by
iv
Holder
STATE OrFLORIDA
COUNTY OF SJ . 1,Je% e
The forgoing instrument was acknowledged before me
this -day of 'So Ylll 20 —fl_ by
(Name of person acknowledging) (Name of person acknowledging )
(Signature of Notary Public- tate of Florida) (Signature of Notary lic-. State of Florida )
Personally Known d �Ew Personally Known OR Produced Identification
Type of Identificat ry'I ��Y d C RGG 022023 Type of Identificat
EXPIRES: December 16.20••'i�"�ft''•. ' DEANNA MARIE GIVENS
Commission No. `. %ledThrugsnTylblicUnderrmtery Commission NoCtMy COMIl RG022023
PIRES: December 16, 2020
'•• o �� ; ; '•• Bonded Thru NotaryPuElic IJnderooitan:
Revised 07/15/2014
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