HomeMy WebLinkAboutBuilding Permit ApplicationAll APPLICABLE INFO MUST BE COMPLETED FOR APPLICATION TO BE ACCEPTED
Date: 10 �a's l i'1 Permit Number:
R � C E I OCT 2S 7017
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 Residential_
PERMIT APPLICATION FOR: co,( -Pc>(-+
roR 39(Pi — 51
Property Tax ID#: 44 32I l -101 COO 1:[ •-000- I Lot No.
Site Plan Name:
Project Name: ® CAP L-1 ON L2C)U N I gy ► !'� I �S
Setbacks 4Front-3oo t Back: Right Side: Left Side:
Additional work to be performed under this permit —check all -that apply:
_Mechanical _ Gas Tank _ Gas Piping Shutters
Electric _Plumbing _Sprinklers, ' -",Generator '-", Generator
Total Sq. Ft of Construction: 103 12 Sq. Ft. of First Floor:
Cost of Construction: $ ,�, 090 - ou Utilities: —Sewer —Septic
Name ®i'�O��hei me- M0►6co ..
Addres _,J(7 6 C . "CU4
`
City: Ft i;d Lucie StateL
Zip Code: Fax:
Phone No. -71-2 65l►, LA.-03Zc)
E-Mail: r x_n
Fill in fee =imp a Title Holder on next page ( if different"
from the Owner listed above)
Name:
Block No.
_ Windows/Doors
Roof Pitch
Building Height:
Company:
Address:
City: State:
Zip Code: Fax:
Phone No
E-Mail
State or County License
If value of construction is 2500 or more, a RECORDED Notice of Commencement is required.
DESIGNER ENGINEER: _ Not Applicable
MORTGAGE COMPANY: Not Applicable
Name: :jc,
_
Name:
Addres
Address:
City: Stat
City: State:
Zip: Phone ,RM6 �3 [�t�lTP-)
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 lender or an attorney before
commencing work or recording our Notice of Commencement.
S nattxr t� +,. ner �essee/Contractor as Agent for Owner
Signature of Contractor License Holder
STATE OF FLORIDA
STATE OF FLORIDA
COUNTY OF f:�icgCVi
COUNTY OF
The forgoing instrument was acknowledged before me
The forgoing instrument was acknowledged before me
this Zaday of QCWht� 20kl by
this day of 20_ by
SARAH GREEN
(Name of person acknowledg
g;W° =_ Notary Public State of FI
r(Na a of person acknowledging )
" Commission # GG 037
44
� My Comm. Expires Oct 6,
020
(Signature of Notary Public- State of Florida)
(Signature of Notary Public- State ofo,Florida) .
Personally Known OR Produced Identification ✓
Personally Known OR Produced Identification
Type of Identification,__ I
r�1o��° LlylsM
Type of Identification
Produced Mgt .P21� .
Produced
Commission No. C (Seal)
Commission No. (Seal)
REVIEWS
FRONT
ZONING
SUPERVISOR
PLANS
VEGETATION
SEA TURTLE
-MANGROVE
COUNTER
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
REVIEW
DATE
;
RECEIVED
DATE
COMPLETED
ev. 7/2014