HomeMy WebLinkAboutBuilding Permit ApplicationALL APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: I ��, �� Permit Number: lids
RECEIVED 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 IMPROVEMENT LOCATfON v k a
Address:
Legal Des
Property Tax.ID #: 4-02- C) 1 Z I - cop ^ Lot No. IL -
Site Plan Name: Block No.
Project Name: _ ,r7 (CL 1 a 1.
Setbacks Front Back: Right Side: Left Side:
Haaltlonal worK to De errormea under this permit —check all apply:
E1HVAC Ei Gas Tank ' .❑Gas Piping _ Shutters Windows/Doors
11 Electric ❑ Plumbing Sprinklers Generator _ Roof Roof pitch
Total Sq. Ft of Construction: S Ft. of First Floor:
Cost of Construction: $ Its ►Q410- S� Utilities:ln Sewer 0Septic Building Height:
Na
Address: ;9 $5"b 5.
City: 31 Y1ScY1' Bb.CV1 State: F�L
Zip Code:Fax:
Phone No. -11OL -adlq"' J9
E-Mail: "51 ()EJ 16:52 C° `%Y>t,a..l. 1. (zWA
Fill in fee simple Title Holder on next page (if different
from the Owner listed above)
Name: AaY)
Company'.
- -- -
City: —fy�A z r i: State:
Zip Code:34 901 y Fax: 5 _ 10-1 %
Phone No. - 3 4
E-Mail: 1 QYIV -1-0 diGC'�tl�i7� l�tti . Y1P"�
State ori'atrftity License:
It value of construction is 52500 or more, a RECORDED Notice of Commencement is required.
DESIGNER/ENGINEER: . ' , _ Not Applica
Name:
Address:
City: State:
Zip: Phone:
FEE SIMPLE TITLE HOLDER: _ Not Applicable
Name:
Address:
City: "
Zip: Phone:
MORTGAGE COMPANY: _ Not Applicable
Name:
Address:
City: State:
Zip: Phone:
BONDING COMPANY: Not Applicable
Name: _
Address:
City:_
Zip:
I certify that no work or installation has commenced prior to the issuance of a permit.
Phone:
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 anyapplical5le"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 reviews 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 andposted on the jobsite
before the firs t:inspection. If you intend to obtain financing, consult with lender or an attorney before
commencing work or recording your Notice of Commencement.
Signature 6f Owner Lessee/Contractor as Agent for Owner
STATE O RI A
COUNTY OF 5 , -
The forgoing instrument was acknowledged before me
thisl'QL% day or5k) VsR 20 11by
/-- "o- hj '0 s
SignaturVOFLORIDA
actor License Holder
STATE
COUNTY OF S k . Ly r,\Q
The forgoing instrument was acknowledged before me
this � day of'S %� • 20 jj_ by
(Name of person acknowledging) (Name of person acknowledging )
(Signature of Notary Publi tate of Florida )
Personally Known OR
Type of Identification Pro.ds
Commission No.114
Revised,07/1 S/2014
(Signature of Notary..P ic- State of Florida )
ed Identification Personally Known
ype of Identificatio P o,lyd d- ARIE GIVENS 111
DEANNA MY COMMISSION.# GG 022023
MdISSION#GG022023 ommission No. 3Ro
ECXPIR S: December 16, 2020 EXPIRES: �er,16, 2020
Bonded Thru Notary Public U derwmtors
I ••.;oF:� `;.•• onded Thru Notary Public Underwriters
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